Microanatomy of the Left and Right Spermatic Cords at Subinguinal Microsurgical Varicocelectomy: Comparative Study of Primary and Redo Repairs

Libman, Jamie; Segal, Robert M.; Baazeem, Abdulaziz; Boman, Jason; Zini, Armand

doi:10.1016/j.urology.2009.11.033

Cited by 14 publications

(25 citation statements)

References 17 publications

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“…The subinguinal varicocelectomy allows for testicular delivery, enabling identification and ligation of collateral veins such as the external spermatic (cremasteric), external pudendal, and gubernacular veins, thus minimizing the risk of recurrence. Libman, et al20 reported that the number of arteries and lymphatic channels identified and preserved at a redo subinguinal microsurgical varicocelectomy was comparable to that observed during a primary microsurgical varicocelectomy. There were no further recurrences after redo varicocelectomy in the current study.…”

Section: Discussionmentioning

confidence: 86%

Recurrent Varicoceles: Causes and Treatment Using Angiography and Magnification Assisted Subinguinal Varicocelectomy

et al. 2012

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PurposeTo investigate the causes of varicocele recurrence and assess the use of embolization and subinguinal varicocelectomy in its treatment in patients with angiography and subinguinal varicocelectomy.Materials and MethodsThe present study involved 15 patients with recurrent varicoceles. The mean patient age was 21.2 years (range: 12-42 years). Preoperative angiography was performed in 11 patients. Embolization was used in patients with patent internal spermatic veins (ISVs). Patients without patent ISVs or preoperative angiography underwent magnification-assisted subinguinal varicocelectomy which included testicular retrieval and ligation of all collateral veins except arteries and deferential veins.ResultsSeven among 11 patients (64%) which had preoperative angiography had patent ISVs and underwent embolization and 8 patients underwent subinguinal varicocelectomy. Of those 8 patients, 6 had dilated ISVs and external spermatic veins (ESVs), one had dilated ISVs and gubernacular veins, and one had dilated ISVs, ESVs and gubernacular veins. No patient experienced recurrence or testis atrophy.ConclusionPatent ISVs or collateral veins may be the cause of recurrence after varicocelectomy. Angiographic embolization was successful in 64% of recurrent varicoceles patients with patent ISVs. However, microscope-assisted subinguinal varicocelectomy may be the best overall treatment for patients with recurrent varicoceles.

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Section: Discussionmentioning

confidence: 86%

Recurrent Varicoceles: Causes and Treatment Using Angiography and Magnification Assisted Subinguinal Varicocelectomy

et al. 2012

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“…Studies have reported that during subinguinal and inguinal microsurgical varicocelectomies, the average numbers of spermatic veins isolated were 11.1 and 8.7, and the average numbers of testicular arteries were 1.6 and 1 respectively (Hopps et al, 2003;Libman et al, 2010). In this study, we performed a microsurgical varicocelectomy above the inner inguinal ring.…”

Section: Discussionmentioning

confidence: 89%

Significant alterations of serum hormone levels in the spermatic vein plexus of patients with varicoceles

et al. 2016

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The objective of this study was to evaluate the level of hormone variation between the peripheral blood and spermatic vein plexus in patients with varicoceles. A total of 23 patients diagnosed with varicoceles were enrolled in the study. All patients underwent a testicular artery-sparing microsurgical varicocelectomy. During the operation, a blood sample from the ipsilateral spermatic vein plexus and a peripheral blood sample were collected. A radioimmunoassay was performed to determine the total testosterone, free testosterone, dihydrotestosterone and oestradiol levels. An enzyme-linked immunosorbent assay was performed to determine the albumin level. The mean age of the patients was 32.3 ± 9.3 years. Compared with the hormone level in the peripheral blood, the total testosterone, free testosterone, dihydrotestosterone, and oestrogen levels were significantly increased in the left or right spermatic vein plexus (P < 0.05). There were no differences in the albumin levels in the peripheral blood and spermatic vein plexus (P > 0.05). The mean total testosterone, free testosterone, dihydrotestosterone, and oestradiol levels in the left spermatic vein plexus were 10.8-fold, 29.0-fold, 2.0-fold, and 26.6-fold those of the peripheral blood. The hormone concentration in the spermatic vein plexus was significantly higher than that in the peripheral blood in patients with varicoceles.

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“…10 Compared with the subinguinal approach, the use of the inguinal approach is associated with fewer internal spermatic veins, easier microscopic dissection and clearer identification of the testicular artery pulsation. 7,8 Ramasamy and Schlegel 11 found that a varicocelectomy without testicular delivery has equivalent or more beneficial effects on semen parameters without affecting varicocele recurrence rates. Orhan et al 12 thought that both inguinal and subinguinal approach microsurgeries were effective methods to use for varicocelectomy.…”

Section: Discussionmentioning

confidence: 99%

“…Some reports 7,8 describe the inguinal varicocele anatomy in American men. To our knowledge, there has been no report describing the intraoperative varicocele anatomy in Asian men.…”

Section: Introductionmentioning

confidence: 99%

Microanatomy of the spermatic cords during microsurgical inguinal varicocelectomy: initial experience in Asian men

Wang

Wang²,

Fu³

et al. 2012

Asian J Androl

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The microanatomy of the inguinal spermatic cords has never been reported in Asia. The purpose of this study was to describe the number and relationship of the veins, arteries and lymphatics in the spermatic cord and to clarify the location of the vas deferens in Asian men. Fifty-one patients receiving 79 primary microsurgical varicocelectomies performed by a single surgeon from April 2011 to July 2012 were studied. The number of internal and external spermatic veins, testicular arteries and lymphatic channels preserved during the inguinal microsurgical varicocelectomy were recorded. The relationship between the right and left vascular anatomy during bilateral varicocelectomies was evaluated. The data showed that mean numbers of 1.560.9 arteries, 5.662.2 spermatic veins and 3.661.9 lymphatics were identified during the repairs. The internal spermatic arteries were surrounded by a dense complex of adherent veins in 81.2% of the cases. The external spermatic vein or veins were found in 60.8% of the cases. The vas deferens may be contained within the internal spermatic fascia. The results suggest that the number of veins may be highly variable and less than those reported in the English literature, but there is some similarity in the inguinal microanatomy of the right and left spermatic cords. Further research is warranted to clarify our results. 1-3 Although the exact cause of infertility in men with a varicocele remains unknown, randomized controlled trials demonstrate that varicocele repair can improve male infertility.

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Microanatomy of the Left and Right Spermatic Cords at Subinguinal Microsurgical Varicocelectomy: Comparative Study of Primary and Redo Repairs

Cited by 14 publications

References 17 publications

Recurrent Varicoceles: Causes and Treatment Using Angiography and Magnification Assisted Subinguinal Varicocelectomy

Recurrent Varicoceles: Causes and Treatment Using Angiography and Magnification Assisted Subinguinal Varicocelectomy

Significant alterations of serum hormone levels in the spermatic vein plexus of patients with varicoceles

Microanatomy of the spermatic cords during microsurgical inguinal varicocelectomy: initial experience in Asian men

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