Abstract:BACKGROUND: A varicocele is a meshwork of distended blood vessels in the scrotum, usually left-sided, due to dilatation of the spermatic vein. Although the concept that a varicocele causes male subfertility has been around for more than 50 years now, the mechanisms by which a varicocele would affect fertility have not yet been satisfactorily explained. Neither is there sufficient evidence to explain the mechanisms by which varicocelectomy would restore fertility. Furthermore, it has been questioned whether a c… Show more
“…The incidence of varicocele in the general population is estimated at 15% 17. A left-sided varicocele is associated with a small risk of malignant obstruction of the renal vein secondary to renal carcinoma 18.…”
A man aged 33 years presented with a 3-day history of left-sided testicular discomfort. Clinical examination revealed a large left-sided varicocele. He was referred for a testicular ultrasound, which demonstrated a moderate left-sided varicocele and an associated large suprarenal mass. An urgent (CT) scan was arranged which confirmed this, with associated compression of adjacent structures, including the left kidney and left renal vessels. The patient was admitted 1 week following the CT scan with features of sepsis. An inpatient adrenal MRI scan suggested the presence of a large left-sided haemorrhagic adrenal cyst. This was removed surgically through a left subcostal incision. Histology confirmed there was no malignancy. The patient was discharged and a follow-up CT scan at 6 months showed complete resolution of the cyst with no further testicular discomfort. This is the first known case of an adrenal cyst presenting with a varicocele.
“…The incidence of varicocele in the general population is estimated at 15% 17. A left-sided varicocele is associated with a small risk of malignant obstruction of the renal vein secondary to renal carcinoma 18.…”
A man aged 33 years presented with a 3-day history of left-sided testicular discomfort. Clinical examination revealed a large left-sided varicocele. He was referred for a testicular ultrasound, which demonstrated a moderate left-sided varicocele and an associated large suprarenal mass. An urgent (CT) scan was arranged which confirmed this, with associated compression of adjacent structures, including the left kidney and left renal vessels. The patient was admitted 1 week following the CT scan with features of sepsis. An inpatient adrenal MRI scan suggested the presence of a large left-sided haemorrhagic adrenal cyst. This was removed surgically through a left subcostal incision. Histology confirmed there was no malignancy. The patient was discharged and a follow-up CT scan at 6 months showed complete resolution of the cyst with no further testicular discomfort. This is the first known case of an adrenal cyst presenting with a varicocele.
“…In this context, a recent Cochraine review in 2012 stated that ‘there is evidence suggesting that treatment of a varicocele in men from couples with otherwise unexplained subfertility may improve a couple's chance of pregnancy’. At the same time, the report highlighted the need for further research with live rate or pregnancy rates as primary outcome and not surrogate markers such as semen analysis.…”
Varicocele embolisation is successful with a low complications rate. Neck and groin access are equally successful with no significant difference in screening time.
The management of infertile men with varicocele is highly debated. Varicocele repair (VR) can be either surgical (varicolectomy) or through angiographic embolization. Surgical repair of varicocele includes open non-microsurgical techniques whether inguinal (Ivanissevich) or high retroperitoneal ligation (Palomo), open microsurgical techniques (inguinal or sub-inguinal) or laparoscopic. The accumulating evidence suggests that VR can improve conventional sperm parameters (sperm concentration, motility, and morphology), seminal oxidative stress, sperm DNA fragmentation, and serum testosterone concentrations.Treatment of cryptorchism is based on surgical correction. The surgical approach for palpable undescended testis is inguinal orchidopexy with eventual repair of concomitant hernia. Scrotal surgical approach is a viable alternative. For nonpalpable undescended testis, surgical approach can be open or laparoscopic, in one or two stages and possibly with spermatic vessel transection. In some cases, orchiectomy is required (testis abdominal localization, impossibility of mobilization or high neoplastic risk).Male accessory gland infections, including infection and/or inflammation of accessory glands (prostate, seminal vesicles, and Cowper’s glands), and male genital tract infections are characterized by the presence of an elevated number of leukocytes and/or pathogens in semen, together with inflammatory signs. Management is based on different antibiotic therapies.
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