[Surgical treatment of varicocele. Our experience in the last 10 years]. 1996

R Bassi, and F Radice, and G Bergami, and F De Grazia, and B Papa
Divisione di Chirurgia Generale, Ospedale S. Marta, Rivolta d'Adda, Cremona.

Varicocele means a varicose dilatation with stretching of the veins in the pampiniform plexus. In the last years the problem of varicocele has emerged again in all its importance for the increasing of couple sterility which, in Italy, is certified to 13%. It is known that this problem is connected to anomalies of the spermiogram, even in the subclinical forms located with the ultrasound method, and that the surgical operation allows to correct in a high percentage of cases. METHODS For treatment of varicocele we use a technique with inguinal approach of 5-6 cm and isolation of all the dilated veins intra- and extrafunicular. After their ligation and section we transpose the funiculus proximally with a little traction on the testicle and we fix it to the great oblique muscle fascia, using margin of cremasteric muscle prepared in advance and distal stumps of resected veins. This manoeuvre forms a short ansa of the funiculus that, in the orthostatic position, helgs to stop the hematic column which weighs on the testicle. This operation has been performed in 54 patients. In 18 (60%), oligoastenospermia was present and 10 (33%) had consulted their physician for sterility problems (4 of them with a sub-clinical varicocele). The patients have been recalled for clinical and echo-doppler control as well qualitative evaluation of the sperm. The follow-up goes from 8 months to 7 years. RESULTS We have noticed the presence of six relapses (13.3%) so divided: 4 relapses with a first grade reflux; 1 relapse with a second grade reflux and 1 relapse with a third grade reflux. Only in two patients with first grade reflux was the spermiogram normal, while in all the others oligoastenospermia persisted. Seric evaluation of testosterone and androstenedione have excluded hormonal causes of sterility. Among the 10 sterile patients 6 (60%), had a normalization of the spermiogram and 4 of them (2 of which with preceding subclinical varicocele), had a partner pregnancy in periods within 7 and 18 months after the operation. CONCLUSIONS On the basis their experience, the authors confirm the validity of the selective varicocelectomy by inguinal approach, with probable further advantage using funicular transposition. To agree with other authors there isn't any very important advantage, in the cost/benefit ratio, between microsurgical diversion and laparoscopic surgery, and traditional varicocelectomy in local anesthesia. The incidence of relapses noticed (13.3%), lower than that rated at the high ligature (29%), is the expression of the anatomic complexity of the spermatic venous drainage, in such a way to think right a phlebographic anterograde intraoperative evaluation. We also confirm the importance of ultrasonographic and ecographic methods in the pre and postoperative evaluation, we underline that, in the subclinical cases, it is possible to verify spermiogram alteration corrected, in a high percentage, by varicocelectomy.

UI MeSH Term Description Entries
D007248 Infertility, Male The inability of the male to effect FERTILIZATION of an OVUM after a specified period of unprotected intercourse. Male sterility is permanent infertility. Sterility, Male,Sub-Fertility, Male,Subfertility, Male,Male Infertility,Male Sterility,Male Sub-Fertility,Male Subfertility,Sub Fertility, Male
D008297 Male Males
D009845 Oligospermia A condition of suboptimal concentration of SPERMATOZOA in the ejaculated SEMEN to ensure successful FERTILIZATION of an OVUM. In humans, oligospermia is defined as a sperm count below 20 million per milliliter semen. Cryptospermia,Cryptozoospermia,Low Sperm Count,Hypospermatogenesis,Oligoasthenoteratozoospermia,Oligozoospermia,Cryptospermias,Cryptozoospermias,Hypospermatogeneses,Low Sperm Counts,Oligoasthenoteratozoospermias,Sperm Count, Low,Sperm Counts, Low
D005500 Follow-Up Studies Studies in which individuals or populations are followed to assess the outcome of exposures, procedures, or effects of a characteristic, e.g., occurrence of disease. Followup Studies,Follow Up Studies,Follow-Up Study,Followup Study,Studies, Follow-Up,Studies, Followup,Study, Follow-Up,Study, Followup
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D013085 Spermatic Cord Either of a pair of tubular structures formed by DUCTUS DEFERENS; ARTERIES; VEINS; LYMPHATIC VESSELS; and nerves. The spermatic cord extends from the deep inguinal ring through the INGUINAL CANAL to the TESTIS in the SCROTUM. Funiculus Spermaticus,Cord, Spermatic,Cords, Spermatic,Spermatic Cords
D014646 Varicocele A condition characterized by the dilated tortuous veins of the SPERMATIC CORD with a marked left-sided predominance. Adverse effect on male fertility occurs when varicocele leads to an increased scrotal (and testicular) temperature and reduced testicular volume. Varicoceles

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