This study investigated the effects of laparoscopic varicocelectomy (LV) and microsurgical subinguinal varicocelectomy (MV) on testicular blood flow and semen quality. Color Doppler Flow Imaging was used to measure blood flow parameters in the testicular arteries before and after surgery. Both LV and MV significantly improved testicular blood flow and semen parameters. However, MV resulted in greater improvements in testicular blood flow earlier after surgery compared to LV. The study concludes that varicocelectomy improves testicular function by enhancing blood supply and microperfusion to the testes.
This document provides an overview of venous physiology assessment techniques performed in vascular laboratories, including ambulatory venous pressure measurement, plethysmography, and duplex ultrasound scanning. It describes how each test is performed and what it evaluates. Ambulatory venous pressure directly measures pressure in foot veins and is considered the gold standard, but it is invasive. Plethysmography uses strain gauges or impedance to estimate volume changes during venous occlusion and identify reflux. Duplex ultrasound combines imaging with Doppler to evaluate veins for deep vein thrombosis, reflux, and stenosis by assessing compressibility and flow. Physiologic testing and ultrasound mapping of reflux guides treatment of venous insufficiency.
Acute SMV thrombosis was described in a document that discussed:
1. It remains a life-threatening condition with high mortality despite advances in treatment.
2. It most commonly involves the superior mesenteric vein and is usually secondary to conditions that increase risk of thrombosis.
3. Presentation can be non-specific with abdominal pain but imaging such as CT can clearly identify thrombosis.
Venous reflux occurs when valves in the veins fail, allowing blood to flow backwards and pool in the legs. This leads to increased venous pressure and microcirculatory damage over time. The pathology involves a fibrin cuff forming from blood cells trapped in the tissues by high pressure, restricting oxygen flow and causing edema, skin changes, and eventually ulcers. Reflux is transmitted from deep to superficial veins through perforating veins, supporting the water hammer effect theory of venous ulcer formation. Chronic venous insufficiency has two components - venous reflux and obstruction - disrupting the normal one-way flow of blood from the feet back to the heart.
Acute aortic syndromes include aortic dissection, intramural hematoma, and penetrating aortic ulcer. They involve a breakdown of the aortic wall layers. Type A dissection requires urgent surgery while type B can be managed medically or with TEVAR for complications. Intramural hematoma and penetrating ulcers are generally treated medically but TEVAR is considered for complications. Guidelines provide algorithms for diagnosis and management based on syndrome type, complications, and patient factors. TEVAR has become preferred over surgery for some conditions when anatomy is favorable.
Introduction: There is growing evidence that Obstructive Sleep Apnea (OSA) is a risk factor for Pulmonary Embolism (PE). This
association represents a major public health burden.Aims and Objectives: To investigate Computed Tomography Obstruction Index (CTOI) and the Right Ventricular (RV) to Left Ventricular (LV) diameter ratio with OSA severity. Materials and Methods: 46 Patients with (PE) were evaluated for OSA. Pulmonary Artery Obstruction Index (PAOI) and RV/ LV diameter ratio was measured by pulmonary angiography. Pulmonary Embolism Severity Index (PESI) was determined. Epworth Sleepiness Scale (ESS) and Polysomnography (PSG) was performed for all patients. Based on the PAOI, patients divided into (< 15%, 15-50%, > 50%).
This document describes the case of a 74-year-old Thai female with a known superior mesenteric vein (SMV) aneurysm. She presented with abdominal discomfort for one month. On examination, her abdomen was moderately distended with mild tenderness in the suprapubic region. The document then reviews definitions, etiology, clinical presentation, complications, and management approaches for SMV aneurysms. It discusses that surgical intervention is usually indicated for symptomatic or expanding aneurysms. Options include aneurysmorrhaphy or aneurysmectomy. For this patient, proper management would involve surgical resection of the aneurysm.
This study prospectively examined cardiac arrhythmias in 90 patients undergoing cardiac surgery at a hospital in Romania between January and June 2017. The study found that postoperative atrial fibrillation was more common in older patients (above 60 years old) with enlarged left atriums. Patients who developed arrhythmias tended to have lower ejection fractions, higher creatinine levels, and more postoperative hemodynamic and renal complications compared to patients without arrhythmias. Risk factors for developing arrhythmias after cardiac surgery included older age, enlarged left atrium, lower arterial oxygen saturation, lower potassium levels, and need for higher doses of inotropic drugs.
Grand Rounds given at Holy Redeemer hospital 1/2017 on the many amazing treatments offered by interventional radiologists.
Including microwave ablation, Y90 radioembolization, UFE, Arterial inteventions, Varicose veins, and more!
This document provides an overview of venous physiology assessment techniques performed in vascular laboratories, including ambulatory venous pressure measurement, plethysmography, and duplex ultrasound scanning. It describes how each test is performed and what it evaluates. Ambulatory venous pressure directly measures pressure in foot veins and is considered the gold standard, but it is invasive. Plethysmography uses strain gauges or impedance to estimate volume changes during venous occlusion and identify reflux. Duplex ultrasound combines imaging with Doppler to evaluate veins for deep vein thrombosis, reflux, and stenosis by assessing compressibility and flow. Physiologic testing and ultrasound mapping of reflux guides treatment of venous insufficiency.
Acute SMV thrombosis was described in a document that discussed:
1. It remains a life-threatening condition with high mortality despite advances in treatment.
2. It most commonly involves the superior mesenteric vein and is usually secondary to conditions that increase risk of thrombosis.
3. Presentation can be non-specific with abdominal pain but imaging such as CT can clearly identify thrombosis.
Venous reflux occurs when valves in the veins fail, allowing blood to flow backwards and pool in the legs. This leads to increased venous pressure and microcirculatory damage over time. The pathology involves a fibrin cuff forming from blood cells trapped in the tissues by high pressure, restricting oxygen flow and causing edema, skin changes, and eventually ulcers. Reflux is transmitted from deep to superficial veins through perforating veins, supporting the water hammer effect theory of venous ulcer formation. Chronic venous insufficiency has two components - venous reflux and obstruction - disrupting the normal one-way flow of blood from the feet back to the heart.
Acute aortic syndromes include aortic dissection, intramural hematoma, and penetrating aortic ulcer. They involve a breakdown of the aortic wall layers. Type A dissection requires urgent surgery while type B can be managed medically or with TEVAR for complications. Intramural hematoma and penetrating ulcers are generally treated medically but TEVAR is considered for complications. Guidelines provide algorithms for diagnosis and management based on syndrome type, complications, and patient factors. TEVAR has become preferred over surgery for some conditions when anatomy is favorable.
Introduction: There is growing evidence that Obstructive Sleep Apnea (OSA) is a risk factor for Pulmonary Embolism (PE). This
association represents a major public health burden.Aims and Objectives: To investigate Computed Tomography Obstruction Index (CTOI) and the Right Ventricular (RV) to Left Ventricular (LV) diameter ratio with OSA severity. Materials and Methods: 46 Patients with (PE) were evaluated for OSA. Pulmonary Artery Obstruction Index (PAOI) and RV/ LV diameter ratio was measured by pulmonary angiography. Pulmonary Embolism Severity Index (PESI) was determined. Epworth Sleepiness Scale (ESS) and Polysomnography (PSG) was performed for all patients. Based on the PAOI, patients divided into (< 15%, 15-50%, > 50%).
This document describes the case of a 74-year-old Thai female with a known superior mesenteric vein (SMV) aneurysm. She presented with abdominal discomfort for one month. On examination, her abdomen was moderately distended with mild tenderness in the suprapubic region. The document then reviews definitions, etiology, clinical presentation, complications, and management approaches for SMV aneurysms. It discusses that surgical intervention is usually indicated for symptomatic or expanding aneurysms. Options include aneurysmorrhaphy or aneurysmectomy. For this patient, proper management would involve surgical resection of the aneurysm.
This study prospectively examined cardiac arrhythmias in 90 patients undergoing cardiac surgery at a hospital in Romania between January and June 2017. The study found that postoperative atrial fibrillation was more common in older patients (above 60 years old) with enlarged left atriums. Patients who developed arrhythmias tended to have lower ejection fractions, higher creatinine levels, and more postoperative hemodynamic and renal complications compared to patients without arrhythmias. Risk factors for developing arrhythmias after cardiac surgery included older age, enlarged left atrium, lower arterial oxygen saturation, lower potassium levels, and need for higher doses of inotropic drugs.
Grand Rounds given at Holy Redeemer hospital 1/2017 on the many amazing treatments offered by interventional radiologists.
Including microwave ablation, Y90 radioembolization, UFE, Arterial inteventions, Varicose veins, and more!
Postoperative chylothorax after cardiothoracicgisa_legal
This study examines the incidence, risk factors, and outcomes of postoperative chylothorax in children undergoing cardiothoracic surgery. The researchers found that the incidence of chylothorax was 3.8% and was significantly higher after heart transplantation, Fontan procedures, and tetralogy of Fallot repairs. Patients with chylothorax had significantly longer hospital stays compared to those without chylothorax. Nutritional management including low fat diets and octreotide were used to treat chylothorax, but surgical interventions provided limited benefit when reserved for severe or prolonged cases. Early diagnosis may reduce the duration of chylothorax.
12.3.61 colonic ischemia in evar & open repair aaaMai Parachy
This document discusses colonic ischemia as a complication following abdominal aortic aneurysm repair. It begins with definitions and reviews colonic anatomy and blood supply. Risk factors for colonic ischemia include ligation of the inferior mesenteric artery during open repair and failure to revascularize hypogastric arteries during endovascular repair. Clinical presentation may include abdominal pain, bleeding, and fever. Diagnosis involves imaging like CT scan and colonoscopy. Treatment depends on severity, with grade I-II managed conservatively and grade III requiring surgery. Preserving inferior mesenteric artery blood flow and promptly treating clinical deterioration can improve outcomes of this serious complication.
The document discusses spinal cord ischemia that can occur during aortic interventions. It outlines the anatomy of the spinal cord blood supply, which involves a network of arteries. Risk factors for spinal cord ischemia include longer aneurysm extent, hypotension, emergency operations, and open repair procedures. The pathophysiology involves impairment of autoregulation and reduction of spinal cord perfusion pressure during aortic occlusion from cross-clamping. Prevention strategies aim to minimize ischemia time, increase tolerance, augment spinal cord perfusion, and allow early detection of ischemia.
1. asian cardiovascular and thoracic annals-2006-olcmen-363-6Gabriel Pacheco
This document summarizes a study examining the role and outcomes of surgery for pulmonary tuberculosis. The study retrospectively analyzed 57 patients who underwent 72 surgical procedures for pulmonary tuberculosis between 1993-2003 at a hospital in Turkey. The most common indications for surgery were trapped lung (31.6%), multidrug-resistant tuberculosis (17.5%), and aspergilloma (17.5%). The most common procedure was lobectomy (31.9%). Complications occurred in 18 patients (24.5% morbidity rate), most commonly prolonged air leak and residual pleural space issues. There was one postoperative death (1.8% mortality rate). The study concludes that surgery can be considered a safe and effective treatment for complications of pulmonary tuberculosis
Thoracoabdominal aortic aneurysms (TAAAs) involve the thoracic and abdominal aorta. They account for 10% of aortic aneurysms and are challenging for anesthesiologists due to risks of paraplegia, renal failure, and other complications during surgery. Pre-operative evaluation of cardiac, pulmonary, and renal function is important for risk assessment and stratification. Proper management and optimization of any co-morbidities is also key to achieving a good surgical outcome.
Lung transplantation involves removing diseased lungs and replacing them with healthy donor lungs. It is an accepted treatment for end-stage lung diseases that do not respond to medical therapy. While outcomes have improved since the first lung transplant in 1963, complications include rejection and infections. Post-transplant, patients experience greatly improved quality of life and lung function, though survival rates decline over time due to chronic lung allograft dysfunction.
This document discusses coronary artery bypass grafting (CABG) using the left internal mammary artery (LIMA) and right internal mammary artery (RIMA). CABG is performed to improve quality of life and reduce mortality in patients with coronary artery disease. Total arterial grafting (TAG), which uses only arterial conduits like the LIMA and RIMA without saphenous vein grafts, provides better long-term outcomes than conventional CABG, though it takes more time and technical skill. While TAG increases short-term sternal wound complications, studies show reduced long-term mortality and major adverse cardiac and cerebrovascular events compared to single internal mammary artery grafting. Therefore, the evidence supports that TAG
This document summarizes management of renal artery stenosis and discusses various treatment options. It outlines moderators and departments from Govt Royapettah Hospital and Kilpauk Medical College in Chennai. It then discusses goals of treatment, the role of revascularization, protocols for medical vs interventional management, and results from studies on angioplasty, stenting, and surgery. Complications and patient selection criteria for different procedures are also outlined.
patients with commissural calcification have a lower
incidence of bilateral com. splitting; have a higher
incidence of severe MR at one year and at 3 years
The document discusses options for difficult forearm arteriovenous fistula (AVF) access for hemodialysis. It describes using basilic or cephalic vein transposition in the forearm when wrist AVF is not available or has failed. The author presents case studies and results from 82 patients who underwent basilic or cephalic vein transposition, finding 96% primary patency and 87% secondary patency after a mean follow up of 32.5 months. Complications occurred in 17% of cases and were mostly treated conservatively without loss of the fistula. The conclusions emphasize that autogenous AVF using transposed forearm veins can provide good patency and should be emphasized for long-term hemod
This document discusses the management of antiplatelet therapy in patients with coronary stents undergoing urologic surgery. It presents guidelines from cardiologic and urologic societies on balancing the risks of bleeding from surgery and thrombosis from discontinuing antiplatelet drugs. For high-risk procedures like TURP, alternatives like laser procedures that reduce bleeding risk even on antiplatelet therapy are recommended. The guidelines stratify thrombotic risk based on stent type and time since placement, and bleeding risk based on procedure invasiveness. They provide recommendations on continuing, holding, or bridging antiplatelet drugs pre- and post-surgery based on thrombotic and bleeding risk levels.
1. AAA can be defined as an abdominal aortic diameter of 3 cm or greater in either the anterior-posterior or transverse plane. Risk factors include male sex, smoking history, and family history of AAA.
2. Screening for AAA is recommended for men aged 65 years or older with a single ultrasound scan. Men aged 60 or older with a family history of AAA in a sibling or parent should also be screened.
3. Elective repair of AAA is recommended when the diameter reaches 5.5 cm for men. Repair may be considered at smaller sizes between 4.5-5.4 cm for younger, low-risk patients. Ruptured AAA requires emergent open surgical repair.
This study investigated the impact of age on the patency of arteriovenous fistulas (AVFs) used for hemodialysis in 442 patients over 7 years. Patients were divided into two groups: those under 40 years old (Group I, n=201) and those over 40 (Group II, n=241). Primary patency rates, defined as the time until any intervention to maintain or reestablish patency or until thrombosis, were found to be lower in patients over 40. The study concludes that more care should be taken when creating AVFs and increased follow-up is needed for older patients, as primary patency rates decrease with age over 40.
1) The document describes the use of off-pump coronary artery bypass grafting (OPCAB) and hybrid procedures combining OPCAB and angioplasty to perform minimally invasive coronary revascularization without cardiopulmonary bypass.
2) Of 216 patients who underwent OPCAB, the procedure was successful in achieving technically complete revascularization in 84% of patients with multivessel disease, either through multivessel OPCAB or a hybrid approach.
3) Postoperative outcomes were good with a low mortality rate of 1.4% and few complications. Graft patency rates improved to over 93% with the use of heart stabilizers during surgery. The hybrid procedures were effective but carried a risk
Carotid Endarterectomy in Stroke Prevention UpdateDenise Crute
This document discusses carotid endarterectomy for stroke prevention. It provides background on strokes, defines different types of strokes, and outlines diagnostic techniques. The bulk of the document focuses on carotid endarterectomy, describing what it is, the history of the procedure, how it is performed, and results from major clinical trials demonstrating its effectiveness in reducing stroke risk compared to medical management alone for patients with significant carotid artery stenosis. The document emphasizes awareness of new techniques and treatments to prevent strokes.
Balloon sizing for percutaneus balloon mitral valvotomy Ramachandra Barik
There are two main methods for determining the appropriate balloon size for percutaneous balloon mitral valvuloplasty (BMV): 1) An empirical formula based on the patient's height or 2) Choosing size based on the maximal inter-commissural distance of the mitral valve as measured by echocardiography. While height-based formulas are commonly used, they have limitations since differences in body habitus are not accounted for. Measurement of the maximal inter-commissural distance via echocardiography is considered a more accurate method for determining balloon size and may provide better outcomes.
A lung transplantation procedure is a surgery which is useful in helping patients with end-stage pulmonary diseases extend their life expectancy as well as improve their quality of life. https://goo.gl/SrVmWN
The document describes a study of 27 patients in Iraq who underwent surgical treatment for left ventricular aneurysms between 2001-2011. Left ventricular aneurysms are complications that can arise after a myocardial infarction. The patients were mostly middle-aged males and had multiple blocked coronary arteries. Surgical techniques used to repair the aneurysms included linear repair and the Dor procedure. Post-operative complications were common, with the highest rate being bleeding. The overall hospital mortality rate for the surgeries was 18.5%.
Percutaneous Balloon Mitral Valvuloplasty (PBMV) involves atrial septostomy during the procedure. One of the consequences of transseptal puncture is the creation of an Atrial Septal Defect (ASD). Transesophageal Echocardiography (TEE) can detect Left to Right (L-R) shunts too small to be detected by other methods. The aim of this study was to evaluate the 3 years follow-up of ASD closure after PBMV by TEE. 200 consecutive patients with rheumatic Mitral Stenosis (MS) who underwent successful PBMV by using the Inoue balloon catheter were studied prospectively. ASD with small L-R atrial shunting occurred in all the patients (100%) immediately after
PBMV. Total study 200 patients. All the ASDs were small in size (≤ 5 mm). The puncture site (ASD site) occurred in the fossa ovalis (Fo.Ov) in 120 patients (60%), while it occurred outside the Fo.Ov (either in the superior limbus or in the inferior limbus of the Interatrial Septum (IAS)) in the other 80 patients (40%). 180 patients presented at 6 month follow-up. ASD was closed in 117 patients (65%), while it was persisted in 63 patients (35%). 95 patients presented at 3 years follow-up. ASD was closed in 76 patients (80%) (Group I), while it was persisted in 19 patients (20%) (Group II). All the 74 patients who had ASD immediately after PBMV in the Fo.Ov, presented with ASD closure at 3 years follow-up. Only 2 patients who had ASD immediately after PBMV outside the Fo.Ov, presented with ASD closure at 3
years follow-up. All the 19 patients who presented at 3 years follow-up with ASD persistence had ASD immediately after PBMV outside the Fo.Ov (14 in the superior limbus and 5 in the inferior limbus). No patient presented at 3 years follow-up with ASD persistence, had ASD immediately after PBMV in the Fo.Ov Large LAD, high total Echocardiographic (echo) score of the Mitral Valve (MV), thick Fo.Ov, thick superior limbus, thick inferior limbus and ASD site immediately after PBMV outside the Fo.Ov were signifi cant predictors of ASD persistence at 3 years follow-up. In conclusion, ASD with L-R atrial shunting occurs in all the patients after PBMV by using the Inoue balloon catheter. ASD after PBMV persists in 20% of the patients at 3 years follow-up. Predictors of ASD persistence at 3 years follow-up are: large LAD, high total echo score of the MV, thick Fo.Ov, thick superior limbus, thick inferior limbus and ASD site immediately after PBMV outside the Fo.Ov. ASD closes at 3 years follow-up in all the patients who had ASD in the Fo.Ov immediately after PBMV. All the patients with ASD persistence
at 3 years follow-up had ASD outside the Fo.Ov after PBMV. It is recommended that operators doing transseptal puncture during PBMV by using the Inoue balloon catheter should aim to do it in the Fo.Ov.
Varicocele repair improves pregnancy rates in men with clinical varicoceles and abnormal semen quality. A meta-analysis of 7 randomized clinical trials found surgical varicocele repair significantly increased pregnancy rates compared to observation alone for men with clinical varicoceles and abnormal semen. The analysis showed no significant difference in pregnancy rates between repair and observation for studies that included men with subclinical varicoceles or normal semen quality. Surgical repair may be an effective first-line treatment for infertility in men with clinical varicoceles and abnormal semen parameters.
Evidence based medicine in management of varicocele 2015Ahmad Motawi
1) Varicocele is the abnormal dilation of the veins within the scrotum that drain blood from the testicles. It is a common cause of male infertility.
2) Treatment options for varicocele include open surgical repair, laparoscopic surgery, and percutaneous embolization or sclerotherapy.
3) Microsurgical repair has a lower recurrence rate compared to open techniques. Meta-analyses show varicocele repair improves semen quality and pregnancy rates for men with a palpable varicocele and abnormal semen parameters.
Postoperative chylothorax after cardiothoracicgisa_legal
This study examines the incidence, risk factors, and outcomes of postoperative chylothorax in children undergoing cardiothoracic surgery. The researchers found that the incidence of chylothorax was 3.8% and was significantly higher after heart transplantation, Fontan procedures, and tetralogy of Fallot repairs. Patients with chylothorax had significantly longer hospital stays compared to those without chylothorax. Nutritional management including low fat diets and octreotide were used to treat chylothorax, but surgical interventions provided limited benefit when reserved for severe or prolonged cases. Early diagnosis may reduce the duration of chylothorax.
12.3.61 colonic ischemia in evar & open repair aaaMai Parachy
This document discusses colonic ischemia as a complication following abdominal aortic aneurysm repair. It begins with definitions and reviews colonic anatomy and blood supply. Risk factors for colonic ischemia include ligation of the inferior mesenteric artery during open repair and failure to revascularize hypogastric arteries during endovascular repair. Clinical presentation may include abdominal pain, bleeding, and fever. Diagnosis involves imaging like CT scan and colonoscopy. Treatment depends on severity, with grade I-II managed conservatively and grade III requiring surgery. Preserving inferior mesenteric artery blood flow and promptly treating clinical deterioration can improve outcomes of this serious complication.
The document discusses spinal cord ischemia that can occur during aortic interventions. It outlines the anatomy of the spinal cord blood supply, which involves a network of arteries. Risk factors for spinal cord ischemia include longer aneurysm extent, hypotension, emergency operations, and open repair procedures. The pathophysiology involves impairment of autoregulation and reduction of spinal cord perfusion pressure during aortic occlusion from cross-clamping. Prevention strategies aim to minimize ischemia time, increase tolerance, augment spinal cord perfusion, and allow early detection of ischemia.
1. asian cardiovascular and thoracic annals-2006-olcmen-363-6Gabriel Pacheco
This document summarizes a study examining the role and outcomes of surgery for pulmonary tuberculosis. The study retrospectively analyzed 57 patients who underwent 72 surgical procedures for pulmonary tuberculosis between 1993-2003 at a hospital in Turkey. The most common indications for surgery were trapped lung (31.6%), multidrug-resistant tuberculosis (17.5%), and aspergilloma (17.5%). The most common procedure was lobectomy (31.9%). Complications occurred in 18 patients (24.5% morbidity rate), most commonly prolonged air leak and residual pleural space issues. There was one postoperative death (1.8% mortality rate). The study concludes that surgery can be considered a safe and effective treatment for complications of pulmonary tuberculosis
Thoracoabdominal aortic aneurysms (TAAAs) involve the thoracic and abdominal aorta. They account for 10% of aortic aneurysms and are challenging for anesthesiologists due to risks of paraplegia, renal failure, and other complications during surgery. Pre-operative evaluation of cardiac, pulmonary, and renal function is important for risk assessment and stratification. Proper management and optimization of any co-morbidities is also key to achieving a good surgical outcome.
Lung transplantation involves removing diseased lungs and replacing them with healthy donor lungs. It is an accepted treatment for end-stage lung diseases that do not respond to medical therapy. While outcomes have improved since the first lung transplant in 1963, complications include rejection and infections. Post-transplant, patients experience greatly improved quality of life and lung function, though survival rates decline over time due to chronic lung allograft dysfunction.
This document discusses coronary artery bypass grafting (CABG) using the left internal mammary artery (LIMA) and right internal mammary artery (RIMA). CABG is performed to improve quality of life and reduce mortality in patients with coronary artery disease. Total arterial grafting (TAG), which uses only arterial conduits like the LIMA and RIMA without saphenous vein grafts, provides better long-term outcomes than conventional CABG, though it takes more time and technical skill. While TAG increases short-term sternal wound complications, studies show reduced long-term mortality and major adverse cardiac and cerebrovascular events compared to single internal mammary artery grafting. Therefore, the evidence supports that TAG
This document summarizes management of renal artery stenosis and discusses various treatment options. It outlines moderators and departments from Govt Royapettah Hospital and Kilpauk Medical College in Chennai. It then discusses goals of treatment, the role of revascularization, protocols for medical vs interventional management, and results from studies on angioplasty, stenting, and surgery. Complications and patient selection criteria for different procedures are also outlined.
patients with commissural calcification have a lower
incidence of bilateral com. splitting; have a higher
incidence of severe MR at one year and at 3 years
The document discusses options for difficult forearm arteriovenous fistula (AVF) access for hemodialysis. It describes using basilic or cephalic vein transposition in the forearm when wrist AVF is not available or has failed. The author presents case studies and results from 82 patients who underwent basilic or cephalic vein transposition, finding 96% primary patency and 87% secondary patency after a mean follow up of 32.5 months. Complications occurred in 17% of cases and were mostly treated conservatively without loss of the fistula. The conclusions emphasize that autogenous AVF using transposed forearm veins can provide good patency and should be emphasized for long-term hemod
This document discusses the management of antiplatelet therapy in patients with coronary stents undergoing urologic surgery. It presents guidelines from cardiologic and urologic societies on balancing the risks of bleeding from surgery and thrombosis from discontinuing antiplatelet drugs. For high-risk procedures like TURP, alternatives like laser procedures that reduce bleeding risk even on antiplatelet therapy are recommended. The guidelines stratify thrombotic risk based on stent type and time since placement, and bleeding risk based on procedure invasiveness. They provide recommendations on continuing, holding, or bridging antiplatelet drugs pre- and post-surgery based on thrombotic and bleeding risk levels.
1. AAA can be defined as an abdominal aortic diameter of 3 cm or greater in either the anterior-posterior or transverse plane. Risk factors include male sex, smoking history, and family history of AAA.
2. Screening for AAA is recommended for men aged 65 years or older with a single ultrasound scan. Men aged 60 or older with a family history of AAA in a sibling or parent should also be screened.
3. Elective repair of AAA is recommended when the diameter reaches 5.5 cm for men. Repair may be considered at smaller sizes between 4.5-5.4 cm for younger, low-risk patients. Ruptured AAA requires emergent open surgical repair.
This study investigated the impact of age on the patency of arteriovenous fistulas (AVFs) used for hemodialysis in 442 patients over 7 years. Patients were divided into two groups: those under 40 years old (Group I, n=201) and those over 40 (Group II, n=241). Primary patency rates, defined as the time until any intervention to maintain or reestablish patency or until thrombosis, were found to be lower in patients over 40. The study concludes that more care should be taken when creating AVFs and increased follow-up is needed for older patients, as primary patency rates decrease with age over 40.
1) The document describes the use of off-pump coronary artery bypass grafting (OPCAB) and hybrid procedures combining OPCAB and angioplasty to perform minimally invasive coronary revascularization without cardiopulmonary bypass.
2) Of 216 patients who underwent OPCAB, the procedure was successful in achieving technically complete revascularization in 84% of patients with multivessel disease, either through multivessel OPCAB or a hybrid approach.
3) Postoperative outcomes were good with a low mortality rate of 1.4% and few complications. Graft patency rates improved to over 93% with the use of heart stabilizers during surgery. The hybrid procedures were effective but carried a risk
Carotid Endarterectomy in Stroke Prevention UpdateDenise Crute
This document discusses carotid endarterectomy for stroke prevention. It provides background on strokes, defines different types of strokes, and outlines diagnostic techniques. The bulk of the document focuses on carotid endarterectomy, describing what it is, the history of the procedure, how it is performed, and results from major clinical trials demonstrating its effectiveness in reducing stroke risk compared to medical management alone for patients with significant carotid artery stenosis. The document emphasizes awareness of new techniques and treatments to prevent strokes.
Balloon sizing for percutaneus balloon mitral valvotomy Ramachandra Barik
There are two main methods for determining the appropriate balloon size for percutaneous balloon mitral valvuloplasty (BMV): 1) An empirical formula based on the patient's height or 2) Choosing size based on the maximal inter-commissural distance of the mitral valve as measured by echocardiography. While height-based formulas are commonly used, they have limitations since differences in body habitus are not accounted for. Measurement of the maximal inter-commissural distance via echocardiography is considered a more accurate method for determining balloon size and may provide better outcomes.
A lung transplantation procedure is a surgery which is useful in helping patients with end-stage pulmonary diseases extend their life expectancy as well as improve their quality of life. https://goo.gl/SrVmWN
The document describes a study of 27 patients in Iraq who underwent surgical treatment for left ventricular aneurysms between 2001-2011. Left ventricular aneurysms are complications that can arise after a myocardial infarction. The patients were mostly middle-aged males and had multiple blocked coronary arteries. Surgical techniques used to repair the aneurysms included linear repair and the Dor procedure. Post-operative complications were common, with the highest rate being bleeding. The overall hospital mortality rate for the surgeries was 18.5%.
Percutaneous Balloon Mitral Valvuloplasty (PBMV) involves atrial septostomy during the procedure. One of the consequences of transseptal puncture is the creation of an Atrial Septal Defect (ASD). Transesophageal Echocardiography (TEE) can detect Left to Right (L-R) shunts too small to be detected by other methods. The aim of this study was to evaluate the 3 years follow-up of ASD closure after PBMV by TEE. 200 consecutive patients with rheumatic Mitral Stenosis (MS) who underwent successful PBMV by using the Inoue balloon catheter were studied prospectively. ASD with small L-R atrial shunting occurred in all the patients (100%) immediately after
PBMV. Total study 200 patients. All the ASDs were small in size (≤ 5 mm). The puncture site (ASD site) occurred in the fossa ovalis (Fo.Ov) in 120 patients (60%), while it occurred outside the Fo.Ov (either in the superior limbus or in the inferior limbus of the Interatrial Septum (IAS)) in the other 80 patients (40%). 180 patients presented at 6 month follow-up. ASD was closed in 117 patients (65%), while it was persisted in 63 patients (35%). 95 patients presented at 3 years follow-up. ASD was closed in 76 patients (80%) (Group I), while it was persisted in 19 patients (20%) (Group II). All the 74 patients who had ASD immediately after PBMV in the Fo.Ov, presented with ASD closure at 3 years follow-up. Only 2 patients who had ASD immediately after PBMV outside the Fo.Ov, presented with ASD closure at 3
years follow-up. All the 19 patients who presented at 3 years follow-up with ASD persistence had ASD immediately after PBMV outside the Fo.Ov (14 in the superior limbus and 5 in the inferior limbus). No patient presented at 3 years follow-up with ASD persistence, had ASD immediately after PBMV in the Fo.Ov Large LAD, high total Echocardiographic (echo) score of the Mitral Valve (MV), thick Fo.Ov, thick superior limbus, thick inferior limbus and ASD site immediately after PBMV outside the Fo.Ov were signifi cant predictors of ASD persistence at 3 years follow-up. In conclusion, ASD with L-R atrial shunting occurs in all the patients after PBMV by using the Inoue balloon catheter. ASD after PBMV persists in 20% of the patients at 3 years follow-up. Predictors of ASD persistence at 3 years follow-up are: large LAD, high total echo score of the MV, thick Fo.Ov, thick superior limbus, thick inferior limbus and ASD site immediately after PBMV outside the Fo.Ov. ASD closes at 3 years follow-up in all the patients who had ASD in the Fo.Ov immediately after PBMV. All the patients with ASD persistence
at 3 years follow-up had ASD outside the Fo.Ov after PBMV. It is recommended that operators doing transseptal puncture during PBMV by using the Inoue balloon catheter should aim to do it in the Fo.Ov.
Varicocele repair improves pregnancy rates in men with clinical varicoceles and abnormal semen quality. A meta-analysis of 7 randomized clinical trials found surgical varicocele repair significantly increased pregnancy rates compared to observation alone for men with clinical varicoceles and abnormal semen. The analysis showed no significant difference in pregnancy rates between repair and observation for studies that included men with subclinical varicoceles or normal semen quality. Surgical repair may be an effective first-line treatment for infertility in men with clinical varicoceles and abnormal semen parameters.
Evidence based medicine in management of varicocele 2015Ahmad Motawi
1) Varicocele is the abnormal dilation of the veins within the scrotum that drain blood from the testicles. It is a common cause of male infertility.
2) Treatment options for varicocele include open surgical repair, laparoscopic surgery, and percutaneous embolization or sclerotherapy.
3) Microsurgical repair has a lower recurrence rate compared to open techniques. Meta-analyses show varicocele repair improves semen quality and pregnancy rates for men with a palpable varicocele and abnormal semen parameters.
Τα Κλινικά Φροντιστήρια "Andrology update” είναι εκπαιδευτικοί κύκλοι μαθημάτων για Ουρολόγους, που διοργανώνει το ΙΜΟΠ. Πρόκειται για τα πλέον πρακτικά φροντιστήρια που ιστορικά έχει υλοποιήσει το Ινστιτούτο, αφού δημιουργούν μία αναπαραστατική εικόνα του ιατρείου των Ουρολόγων και οι συνάδελφοι βρίσκονται αντιμέτωποι με καθημερινά προβλήματα που αντιμετωπίζουν και στο ίδιο το ιατρείο τους. Κατ’ αυτόν τον τρόπο, και μέσα από την αναγκαία μίξη της τεκμηριωμένης ιατρικής και της κλινικής εμπειρίας, εξασφαλίζεται η ανανέωση της γνώσης.
Σύνδεσμοι που σας ενδιαφέρουν:
• Γενικές Πληροφορίες: http://bit.ly/agria2016info
• Ομιλητές: http://bit.ly/agria2016omilites
• Πρόγραμμα: http://bit.ly/agria2016program
• Πρόγραμμα ISSU: http://bit.ly/agria2016issu
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Πρόγραμμα για το 9ο Ελληνικό Διαδραστικό Σχολείο Ουρολογίας, UROSchool, που διοργανώνει το Ινστιτούτο Μελέτης Ουρολογικών Παθήσεων από το 2008 και κάθε χρόνο στην Πορταριά Πηλίου. Ένα μεγάλο ευχαριστώ στους εκπαιδευτές που ήδη δουλεύουν για να ανταποκριθούν στις προσδοκίες των Ουρολόγων.
Σύνδεσμοι που σας ενδιαφέρουν:
Πρόγραμμα: http://bit.ly/uroschool2016program
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Φόρμα Εκδήλωσης Ενδιαφέροντος: http://bit.ly/uroschool2016
(για την φόρμα εκδήλωσης ενδιαφέροντος Θα πρέπει να εισέλθετε ή να εγγραφείτε στην ιστοσελίδα του ΙΜΟΠ)
Το πρόγραμμα για το 10ο Ελληνικό Διαδραστικό Σχολείο Ουρολογίας που θα γίνει στις 16-19 Φεβρουαρίου 2017 στην Πορταρία του Πηλίου.
Εκδήλωση ενδιαφέροντος: http://bit.ly/uroschool2017
Evaluation of Obstructive Uropathy with Computed Tomography Urography and Mag...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This study examined the relationship between volume overhydration and endothelial dysfunction in 81 stable patients on continuous ambulatory peritoneal dialysis. Volume status was assessed by normalized extracellular water and endothelial function was estimated by flow-mediated dilation of the brachial artery. There was an independent correlation between the index of volume status (normalized extracellular water) and endothelial function (flow-mediated dilation), with higher normalized extracellular water related to worse endothelial function. Multiple regression analysis identified calcium-phosphate product, normalized extracellular water, and dialysis vintage as independent determinants of endothelial function. The results suggest that volume overhydration may lead to increased cardiovascular risk in dialysis patients through its effects on endothelial dysfunction.
This document summarizes two studies on percutaneous left ventricular assist devices (LVADs) and coronary artery fistulas.
The first study investigated the ability of a percutaneous LVAD to deliver blood to the systemic circulation during cardiac arrest in pigs. The LVAD maintained blood flow and preferentially perfused vital organs like the brain. Intensified fluid loading further improved LVAD performance.
The second study evaluated the microvascular effects of ultrasound contrast (Definity) in hamsters with conditions like ischemia-reperfusion, diabetes, and sepsis. Inflammatory responses were higher in diabetes with ischemia and sepsis groups, independent of contrast use. Contrast did not alter hemodynamics or reology.
The study investigated the incidence and risk factors of venous obstruction before and after implantation of transvenous pacing leads in 131 patients using digital subtraction angiography (DSA). DSA was performed before implantation and at 44 months follow-up in 79 patients. Prior to implantation, venous obstruction was found in 18 patients (13.7%), mainly in the left innominate vein. After implantation, venous obstruction occurred in 26 of 79 patients (32.9%) at follow-up DSA. There were no significant differences in risk factors between patients with or without obstruction. The incidence of obstruction after implantation was lower than previous reports, possibly due to pre-existing obstruction being identified prior to implantation.
Purpose: To assess the effectiveness of a fast track referral system from Vascular Laboratory to Interventional Radiology on
threatened vein bypass grafts in the lower limbs.
Methods: A Fast Track System (FTS) was set up in February 2011 to minimise the delay from duplex scan to intervention for bypass grafts with identifi ed signifi cant stenoses. 111 scans were performed pre - FTS over one year and compared with 190 scans which were performed post-FTS introduction over two years.
1. The document discusses Chronic Cerebrospinal Venous Insufficiency (CCSVI), a condition linked to multiple sclerosis (MS) where veins draining the brain and spinal cord are narrowed or blocked.
2. It provides details on diagnosing and treating CCSVI using procedures like Doppler ultrasound, MRI, venography, and venous angioplasty to widen blocked veins.
3. While the relationship between CCSVI and MS is still being studied, the document reports that over 600 MS patients treated for CCSVI experienced reduced fatigue, improved quality of life, psychological state, and physical condition based on evaluation scales.
MDCT Evaluation of Varices in Portal HypertensionVishwanath R S
MDCT is useful for identifying portosystemic collateral vessels in patients with portal hypertension. It can accurately demonstrate the majority of collateral channels. Dynamic CT with contrast allows visualization of varices in the esophagus, stomach, rectum, and other locations. Precise mapping of collateral vessels is important before surgical or interventional procedures to avoid blood loss. MDCT plays an invaluable role in managing portal hypertension.
1) The study evaluated the effects of previous unsuccessful extracorporeal shockwave lithotripsy (ESWL) treatments on percutaneous nephrolithotomy (PCNL) outcomes.
2) 393 patients undergoing PCNL were divided into two groups - those who had previous ESWL treatment (Group 1, 143 patients) and those who did not (Group 2, 250 patients).
3) The study found that patients in Group 1 who had previous ESWL experienced greater decreases in hemoglobin levels, higher rates of blood transfusions, and more bleeding during PCNL compared to Group 2 patients who did not have previous ESWL. However, stone-free rates and lengths
Low Ligation of Inferior Mesenteric Artery in Laparoscopic Anterior Resection...King Hussien Cancer Center
This randomized controlled trial compared low ligation versus high ligation of the inferior mesenteric artery during laparoscopic anterior resection for rectal cancer. The primary outcome was genitourinary dysfunction assessed through validated questionnaires and uroflowmetry at 1 and 9 months postoperatively. Results showed that both techniques resulted in impaired genitourinary function, though low ligation led to less worsening of symptoms over time. There were no significant differences in secondary outcomes like complications or oncological adequacy between the groups. In summary, low ligation of the inferior mesenteric artery better preserved genitourinary function after surgery without compromising other outcomes.
Transrectal ultrasound guided prostate biopsies in patients taking aspirin fo...anemo_site
This study analyzed whether continued aspirin use increases the risk of bleeding complications from transrectal ultrasound-guided prostate biopsies. A meta-analysis was conducted of 3218 patients from published studies and the authors' own series. The results showed a small increased risk of minor hematuria in aspirin users, but no increased risk of moderate or severe hematuria. Rectal bleeding and hematospermia risks were also not significantly increased. The study concludes that continuing aspirin use does not increase overall bleeding risks from prostate biopsies and stopping aspirin before the procedure is unnecessary.
This study analyzed factors contributing to delays in relaparotomy for patients experiencing anastomotic leakage after colorectal resection. The median time between first documented clinical signs of leakage and relaparotomy was 3.5 days. Delays were significantly longer when the period between initial signs and relaparotomy included a weekend (4.2 days vs 2.4 days) or when radiological evaluation provided a false negative result (8.1 days vs 3.5 days). While over two-thirds of patients experienced delays over two days, delays did not significantly impact additional procedures, length of stay, or mortality.
Intraoperative Plain Balloon Angioplasty to Augment Creation of Radiocephalic...semualkaira
The native small cephalic vein may be overlooked during radiocephalic Arteriovenous Fistula (AVF) creation due to concerns over failure rates particularly if the diameter is small. However, native access has benefits in patency and infection risk in selected patients over alternatives such as arteriovenous graft or tunneled hemodialysis catheter. The aim of this study was to review the outcomes of intraoperative Plain Balloon Angioplasty (PBA) in patients with small cephalic veins during AVF creation. We evaluated the maturation, primary and secondary patency rate of salvaged arteriovenous fistulae and identified risk factors related to patency rate.
Intraoperative Plain Balloon Angioplasty to Augment Creation of Radiocephalic...semualkaira
The native small cephalic vein may be overlooked during radiocephalic Arteriovenous Fistula (AVF) creation
due to concerns over failure rates particularly if the diameter is
small. However, native access has benefits in patency and infection risk in selected patients over alternatives such as arteriovenous graft or tunneled hemodialysis catheter. The aim of this
study was to review the outcomes of intraoperative Plain Balloon
Angioplasty (PBA) in patients with small cephalic veins during
AVF creation. We evaluated the maturation, primary and secondary patency rate of salvaged arteriovenous fistulae and identified
risk factors related to patency rate.
Intraoperative Plain Balloon Angioplasty to Augment Creation of Radiocephalic...semualkaira
The native small cephalic vein may be overlooked during radiocephalic Arteriovenous Fistula (AVF) creation
due to concerns over failure rates particularly if the diameter is
small. However, native access has benefits in patency and infection risk in selected patients over alternatives such as arteriovenous graft or tunneled hemodialysis catheter. The aim of this
study was to review the outcomes of intraoperative Plain Balloon
Angioplasty (PBA) in patients with small cephalic veins during
AVF creation. We evaluated the maturation, primary and secondary patency rate of salvaged arteriovenous fistulae and identified
risk factors related to patency rate.
Intraoperative Plain Balloon Angioplasty to Augment Creation of Radiocephalic...semualkaira
The native small cephalic vein may be overlooked during radiocephalic Arteriovenous Fistula (AVF) creation
due to concerns over failure rates particularly if the diameter is
small. However, native access has benefits in patency and infection risk in selected patients over alternatives such as arteriovenous graft or tunneled hemodialysis catheter. The aim of this
study was to review the outcomes of intraoperative Plain Balloon
Angioplasty (PBA) in patients with small cephalic veins during
AVF creation. We evaluated the maturation, primary and secondary patency rate of salvaged arteriovenous fistulae and identified
risk factors related to patency rate.
Role of retrograde transpopliteal angioplasty for superficial femoral artery ...SAMEH ATTIA ALI ABDELHAMID
This document discusses retrograde transpopliteal angioplasty for treating superficial femoral artery occlusion. It provides details on:
- The inclusion/exclusion criteria for patients in the study evaluating this technique's effectiveness and safety.
- The procedure, which involves accessing the popliteal artery from behind the knee and recanalizing the femoral artery in a retrograde manner.
- The results of the study, which found the technique achieved technical success in all cases and led to significantly improved ankle-brachial indices. Post-operative complications were minor. At 6-month and 1-year follow-ups, most arteries remained patent.
- The conclusion that retrograde popliteal access is a
This meta-analysis compared the effectiveness of surgical procedures for portal hypertension, including selective or nonselective shunts, devascularization, and combined shunt and devascularization. It found that shunt procedures were more effective at reducing rebleeding compared to devascularization alone, but also carried a higher risk of encephalopathy. Combined shunt and devascularization was more effective at reducing portal vein pressure and rebleeding than devascularization alone. There were no significant differences in outcomes between selective and nonselective shunts. The analysis was based on data from randomized controlled trials involving over 1000 patients with portal hypertension.
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How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
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Efek varicocelectomy tentang aliran arteri antara laaproskopik dengan mikro
1. SEXUAL DYSFUNCTION AND INFERTILITY
The Effects of Varicocelectomy on Testicular Arterial Blood Flow: Laparo-
scopic Surgery versus Microsurgery
Minghui Zhang,1,2
Lizhen Du,2
Zhijun Liu,2
Hengtao Qi,3
Qiang Chu2*
Purpose: To investigate the long term effects of laparoscopic varicocelectomy (LV) and microsurgical subinguinal
varicocelectomy (MV) on ipsilateral testicular microcirculation using Color Doppler Flow Imaging (CDFI).
Materials and Methods: A total of 29 patients with left varicocele who underwent LV and 30 patients who under-
went MV were examined with CDFI for intratesticular flow parameters before and at 3- and 6-month after surgery.
Preoperative and postoperative semen parameters were also evaluated.
Results: The mean values of peak systolic velocity, pulsatility index (PI) and resistive index (RI) of capsular artery
(CA) and intratesticular artery (ITA) decreased significantly after LV and MV, whereas no significant change was
observed in end-diastolic velocity. Comparing between two groups, the PI and RI values of left CA and ITA on 3rd
month and of ITA on 6th
month postoperatively in MV group were significantly lower than those in LV group. LV
and MV resulted in a statistically increase in the sperm density, morphology and total motile sperm count. Moreover,
the PI and RI values of ipsilateral CA and ITA seemed negatively correlated with sperm quality.
Conclusion: A significant improvement occurs in testicular blood supply and sperm parameters after either LV or
MV, among MV advances an early and a more obvious hemodynamics promotion than LV. The values of RI and PI
of ipsilateral CA and ITA are two important indexes for the prognosis after varicocelectomy.
Keywords: laparoscopy; microsurgery; postoperative complications; spermatic cord; varicocele; surgery; treatment
outcome.
INTRODUCTION
Varicocele is defined as the hemodynamic impair-
ment of testicular venous network with continu-
ous blood reflux in pampiniform plexus and char-
acterized by the abnormal dilation and retrograde flow
in the affected veins.(1)
The estimated incidence of var-
icocele is about 20% in the general population rising to
almost 40% in subfertile men.(2)
The effects of varicocele
include reduced ipsilateral testicular volume, impaired
sperm production ranging from oligozoospermia to com-
plete azoospermia, and reduced fertility.(3)
Although pro-
posed factors, as elevated testicular temperature caused
by increased testicular blood flow, venous stasis second-
ary to increased venous pressure, reflux of adrenal/renal
metabolites, hormonal imbalance and directly injuries
due to the generation of excessive reactive oxygen spe-
cies, may partly explain the impaired spermatogenesis,
the exact mechanisms of the deleterious effects of varico-
cele on spermatogenesis are poorly understood.(3-6)
The method for treatment of varicocele is mainly vari-
cocelectomy, though various approaches exist, including
traditional open inguinal (Ivanissevich)/high retroperito-
neal (Palomo), laparoscopic, microscopic inguinal and
microscopic subinguinal surgery. Regardless of these
different approaches, changes in semen parameters af-
ter varicocelectomy have been well demonstrated, with
improved sperm concentration, motility and morpholo-
gy and increased total motile sperm counts (TMSC) and
pregnancy rates.(2,3,7)
Nevertheless, pathophysiology of
this relationship between improved semen quality and
varicocelectomy remains controversial.(8)
It is hypothe-
sized that impaired venous drainage causes increase in
venous pressure of the spermatic veins. The condition of
venous stasis may decrease the arterial blood supply and
microperfusion of the testes by down-regulating arterial
inflow to maintain the homeostasis of the intratesticular
vascular pressure, thus inducing hypoxia and deficiency
in testicular microcirculation.(2,9)
Besides, it is thought
that, this hypoxia could be responsible for defective ener-
gy metabolism at mitochondrial levels causing dysfunc-
tion of both Leydig and germinal cells.(4,5,10)
The arterial supply to the testis has three major compo-
nents: the testicular artery (TA), the cremasteric artery
and the deferential artery, among which two thirds are
supplied by TA. TA divides into two branches in testis,
while the capsular artery (CA) continues in the surface of
1
Department of Ultrasound, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing 100037, China.
2
Department of Ultrasound, Qingdao Municipal Hospital, Qingdao University, Qingdao 266071, China.
3
Department of Ultrasound, Shandong Medical Imaging Research Institute, Shandong University, Jinan 250021, China.
* Correspondence: Department of Ultrasound, Qingdao Municipal Hospital, Qingdao University, No. 5, Donghaizhong Rd., Qingdao 266071, China.
Tel: +86 532 88905330; Fax: +86 532 85968434. E-mail: qdultrasound@gmail.com.
Received March 2014 & Accepted June 2014
Sexual Dysfunction and Infertility 1900
2. the testis and the intratesticular artery (ITA) in the paren-
chyma and deep.(11)
Previous studies indicate that Color
Doppler Flow Imaging (CDFI) is well established to il-
lustrate macro-microvascularity and therefore perfusion
of the testis.(10-12)
The arterial flow velocities (peak sys-
tolic velocity, PSV, and end diastolic velocity, EDV) and
the resistance indices against this flow (resistive index,
RI, and pulsatility index, PI) in the testis can be accurate-
ly measured with CDFI technique.
In our hospital, microsurgical subinguinal varicocelecto-
my (MV) has been the principle method in the latest two
years, however, laparoscopic varicocelectomy (LV) was
the mainstream before. The aim of this study is to investi-
gate the effects of varicocelectomy, both LV and MV, on
testicular arterial blood flow using CDFI, and to clarify
whether the present MV is superior to the previous LV.
MATERIALS AND METHODS
Study Patients
A total of 59 adults with clinical left varicocele and with
various scrotal complaints were included (Table 1). The
varicocele had been detected on physical examination and
scrotal ultrasonography. No comorbidities such as hy-
pertension, diabetes, psoriasis, or other internal diseases
existed, besides bilateral/subclinical/recurrent varicocele,
history of varicocelectomy and azoospermia, any scrotal
pathology other than varicocele were also excluded. LV
was performed during May 2010 and November 2011,
and MV was performed since January 2012. The same
surgeon (ZL) performed either of the two operations in
all patients, and all patients were obligated to have fol-
low-up visits including physical and sonographic exam-
inations 3 and 6 months after surgery. Informed consent
was obtained from all patients, and the study protocol was
approved by the ethics committee of our hospital (QMH-
20100046, QMH-20120013).
Color Doppler Ultrasonographic Examination
All patients were examined via GE Logiq 9 Ultrasound
System using a 9.0~12.0 MHz linear-array transducer
(GE Medical Systems, LLC, Milwaukee, WI, USA) in
the supine position during normal respiration and during
Valsalva maneuver. The diagnostic criteria for varicocele
were as the common view.(13)
All patients were studied
between 16:00 and 18:00 pm in a warm quiet room and
they rested for at least 15 min before the ultrasonography.
Routine scrotal ultrasonography was analyzed for testicu-
lar size. The volume of the testis was calculated using the
formula for a prolate ellipse (A × B × C × 0.52), where
A, B and C are the 3 longest diameters of the testis.(14)
The left intratesticular blood flow parameters were mea-
sured just prior to surgery and were repeated at 3rd and
6th
months follow-up, moreover parameters of the right
side were measured as control. Built-in software was used
for automatic calculation, on the frozen spectral display,
of the PSV, EDV, RI and PI on spectral Doppler wave-
forms. RI was calculated as [(PSV-EDV)/PSV]. PI was
calculated as [(PSV-EDV)/TAMaxV], with TAMaxV
= time-averaged maximum flow velocity. The Doppler
sample window was set at 1 mm. On each Doppler trac-
ing, measurements were performed only when the wave-
form modulation and amplitude remained stable on at
least three consecutive cardiac cycles. All the exams were
done by the same researcher (MZ) and reevaluated by an-
other researcher (QC). We had calculated a κ between the
researcher (P = .910).
Surgery
Laparoscopic Varicocelectomy (LV)
Patients were placed in a right lateral low lithotomy po-
sition under general anesthesia. Three ports (one 10- and
two 5-mm trocars) were placed in a triangle formation,
with a camera port (10 mm) just below the umbilicus and
the other two ports at the lateral border of each rectus
abdominis muscle. After dissecting the adhesion between
the intestine/mesentery and the varicoceles if exist, a ret-
roperitoneal incision was made in the lateral aspect from
the point 3 cm superior to the internal inguinal ring along
Variables LV Group (n = 29) MV Group (n = 30) Total (n = 59) P Value
Patients number 29 30 59
Grade of varicocele
Grade II 20 19 39
Grade III 9 11 20 .785
Chief complaint
Pain 10 9 19
Mass 13 9 22
Infertility 6 12 18 .251
Age (range, years) 18-35 18-35 -----
Age (median, years) 23 24 ----- .484
Table 1. Demographic and clinical characteristics of patients in study groups.
Abbreviations: LV, laparoscopic varicocelectomy; MV, microsurgical subinguinal varicocelectomy.
Variables LV Group MV Group
Patients number 29 30
Preoperative (Left) 12.71 ± 2.16 12.63 ± 3.08
3 months 13.01 ± 2.96 12.87 ± 2.91
6 months 12.97 ± 2.67 12.83 ± 3.14
Preoperative (Right) 13.04 ± 3.02 12.76 ± 3.03
3 months 12.94 ± 3.40 12.73 ± 3.29
6 months 13.11 ± 3.12 12.89 ± 3.33
Abbreviations: LV, laparoscopic varicocelectomy; MV, microsur-
gical subinguinal varicocelectomy.
* All P values are statistically non-significant (P > .05).
Table 2. Testicular volume (mL, mean ± SD) of patients in study
groups.*
Varicocelectomy Affects Testicular Supply-Zhang et al
Vol 11. No 05 Sept-Oct 2014 1901
3. the testicular vessels. The lymphatic vessels and TA were
identified and likewise preserved. The para-arterial veins
that paralleled or sandwiched the TA were separated, li-
gated by Hem-o-lok clips (Weck Closure Systems, Re-
search Triangle Park, NC, 27709, USA) and cut.(1)
Pa-
tients were discharge on the second post-operative day
(POD2).
Microsurgery Subinguinal Varicocelectomy (MV)
Patients were placed in the supine position after induc-
tion of adequate spinal anesthesia. A 2.5 cm subinguinal
incision was made and the testicle was then delivered.
Through the operating microscope at 6-15 × magnifica-
tion, the vas deferens, vasal vessels, TA (or TAs) and as
lymphatic channels as possible were preserved, all inter-
nal spermatic veins were identified and dissected and then
ligated with 4-0 Mersilk sutures (Ethicon Inc., Shanghai,
China). The spermatic cord was then repeatedly exam-
ined until no veins other than deferential veins remain.
The gubernaculum was also thinned sufficiently so that
veins on both sides can be identified and ligated.(10)
The
spermatic cord was last returned to its bed. Incision was
closed layers by layers, while skin closure was performed
with sterile strip enforcement. Patients were discharge on
the next day (POD1).
Semen Analysis
Semen specimens were collected on site after two-five
days of sexual abstinence preoperatively and repeated at
6th
month after surgery, and only from the subfertile and
patients who were married and receptive to the test, as se-
men collection by masturbation was somehow ridiculous
for the virgin boys. Sperm concentration, motility and
morphology were assessed using World Health Organi-
zation (WHO) 2010 manual for the Examination and Pro-
cessing of Human Semen.(15)
TMSC (i.e., ejaculate vol-
ume × concentration × motile fraction) was calculated. A
50% or more TMSC increase from baseline was accepted
Capsular Artery Intratesticular Artery
Variables
PSV(cm/s) EDV(cm/s) PI RI PSV(cm/s) EDV(cm/s) PI RI
Preoperative 10.71±3.53 3.62 ± 1.67 1.07 ± 0.19 0.62 ± 0.09 7.23 ± 1.17 3.32 ± 0.77 0.91 ± 0.11 0.59 ± 0.06
(Left)
3months 9.17 ±1.97** 3.51±1.39 0.98 ± 0.11** 0.55 ± 0.06‡ 6.77 ±1.04 3.21 ± 0.69 0.82 ± 0.09† 0.55 ± 0.05†
6months 9.18 ±1.92** 3.52 ±1.47 0.92 ± 0.09‡§ 0.53 ± 0.05‡ 6.47 ± 0.98† 3.19 ± 0.73 0.79 ± 0.07‡ 0.54 ± 0.04‡
Preoperative 9.52 ± 3.96 3.59 ±1.52 1.11 ± 0.34 0.60 ± 0.08 7.06 ± 0.97 3.26 ± 0.67 0.83± 0.11 0.54 ± 0.07
(Right)
3months 9.53±3.66 3.64 ± 1.40 1.02 ± 0.28 0.59 ± 0.06 7.07 ± 1.01 3.21 ± 0.59 0.86 ± 0.10 0.56 ± 0.07
6months 9.51±3.38 3.55 ± 1.05 1.05 ± 0.27 0.61 ± 0.09 7.03 ±1.09 3.11 ± 0.71 0.87 ± 0.13 0.57 ± 0.09
Abbreviations: LV, laparoscopic varicocelectomy; PSV, peak systolic velocity; EDV, end diastolic velocity; PI, pulsatility index; RI, resistive index.
* Data are presented as mean ± SD.
** P < .05 compared with the preoperative data.
† P < .01 compared with the preoperative data.
‡ P < .001 compared with the preoperative data.
§ P < .05 data of 6th month postoperatively compared to that of 3rd month, P = .0269 exactly.
Table 3. Comparison of preoperative and postoperative blood flow parameters in both testes (LV group, n = 29).*
Capsular Artery Intratesticular Artery
Variables
PSV(cm/s) EDV(cm/s) PI RI PSV(cm/s) EDV(cm/s) PI RI
Preoperative 11.11± 4.04 3.79 ±1.76 1.11± 0.20 0.60 ± 0.12 7.13±1.50 3.30 ± 0.85 0.97 ± 0.17 0.58± 0.08
(Left)
3months 9.28 ± 2.54** 3.62 ±1.67 0.91± 0.14‡# 0.52 ± 0.05†# 6.43± 0.99** 3.29 ± 0.73 0.69 ± 0.17‡& 0.49 ± 0.06‡&
6months 9.17± 2.83** 3.65 ±1.93 0.92± 0.15‡ 0.54 ±0.06** 6.58 ±1.16 3.31 ± 0.69 0.67 ± 0.15‡& 0.50 ± 0.07**$
Preoperative 9.17± 3.34 3.44 ±1.60 1.01± 0.44 0.59±0.12 7.22± 0.87 3.27 ± 0.76 0.87 ± 0.12 0.55 ± 0.07
(Right)
3months 9.23±3.82 3.61±1.54 1.13 ± 0.39 0.62± 0.11 7.19 ± 0.91 3.20 ±0.50 0.84 ± 0.17 0.53 ± 0.06
6months 9.21±3.11 3.57±1.37 1.15 ± 0.31 0.61± 0.13 7.23±1.00 3.21±0.61 0.88 ± 0.13 0.54 ±0.08
Abbreviations: MV, microsurgical subinguinal varicocelectomy; PSV, peak systolic velocity; EDV, end diastolic velocity; PI, pulsatility index; RI, resistive index.
* Data are presented as mean ± SD.
** P < .05 compared with the preoperative data.
† P < .01 comparing to the preoperative data
‡ P < .001 comparing to the preoperative data.
Data comparison of the same time point between the two groups, Table 3 and Table 4:
# P < .05; $ P < .01; & P < .001.
Table 4. Comparison of preoperative and postoperative blood flow parameters in both testes (MV group, n = 30).*
Varicocelectomy Affects Testicular Supply-Zhang et al
Sexual Dysfunction and Infertility 1902
4. as a significant improvement in the semen parameters.(12)
Statistical Analysis
PASW Statistics version 18.0 software (IBM SPSS Inc.,
Chicago, IL, USA) was used for statistical analysis. Re-
sults were expressed as the mean ± standard deviation.
The demographic data were compared using a chi-square
or Mann-Whitney U test, and pre- and postoperative data
were compared using a Student’s t-test for paired sam-
ples. A P value of < .05 was considered statistically sig-
nificant.
RESULTS
Patients’ information is summarized in Table 1. No oper-
ative or postoperative complication was observed within
six months, and no post-operative varicocele recurrence
was identified. No participants were lost to follow up,
as they were all local citizens. In LV group, 50% (5/10)
of patients with the chief complaint of pain and 84.6%
(11/13) of patients with the complaint of mass were
cured, and the rest were relieved; while in MV group, the
cure rate was 88.9% (8/9) no matter complaining of pain
or mass, and then the relieve rate was 11.1% (1/9). No
couple achieved spontaneous pregnancy within the fol-
low-up in either group.
The mean testicular volumes for the LV and MV groups
are presented in Table 2. There was no statistically sig-
nificant difference among the pre- and postoperative val-
ues within either LV or MV group (P > .05). There was
also no statistically significant difference in those values
for the testes between the two groups (P > .05).
All the preoperative and postoperative blood flow pa-
rameters in both testes are listed in Table 3 and Table 4.
Within each (LV or MV) group, the values of RI, PI and
PSV in the left ITA and CA decreased significantly after
surgery (P < .05), among which the values of RI and PI
seemed more sensitive than PSV (with smaller P values),
and those of 6th
month were insignificantly lower (P >
.05) than 3rd month postoperatively except PI of CA in
LV group (P < .05). No significant change was observed
in EDV (P > .05). No differences were detected in the
right ITA and CA between the preoperative and postop-
erative blood flow parameters (P > .05). Comparing be-
tween two groups, the initial (preoperative) parameters
were statistically equal (P > .05), but the interim data (3rd
month postoperative), the values of PI and RI of CA and
ITA, in MV group were significantly lower than those in
LV group (P < .05), moreover in the ultimate (6th month
postoperative) data, the values of PI and RI of ITA were
also lower in MV group (P < .01). Of study participants
41.4% (12/29) and 46.7% (14/30) of patients underwent
semen analyses in LV and MV groups, respectively (Ta-
ble 5). In both groups, sperm density, percent normal
morphology, and TMSC were improved after surgery (P
< .05), however, sperm motility remained unchanged (P
> .05). TMSC was the most important indicator of sperm
quality, and ≥ 50% TMSC increase postoperatively was
considered as a meaningful improvement.(12)
According
to this criteria, TMSC improved (≥ 50%) in 66.7% (8/12)
and 78.6% (11/14) of patients in LV and MV groups,
respectively, the rest remained unchanged (< 50% in-
crease). The preoperative and postoperative mean CDFI
values were respectively listed in Table 5 in the 19 pa-
tients with TMSC improvement versus in the remaining 7
patients with no semen improvement. In TMSC improved
subgroup, the values of PI and RI of ipsilateral CA and
ITA were significantly decreased (P < .05), whereas in
TMSC unchanged subgroup, the values of PI and RI of
LVGroup(n=12) MVGroup(n=14)
Parameters
Preoperative Postoperative PValue Preoperative Postoperative PValue
Totalmotilespermcounts(million) 63.69±16.60 92.72±17.73 .0004 60.11±18.25 96.08±20.44 <.0001
Spermcount(million/mL) 34.23±9.30 53.91±12.06 .0002 32.74±9.41 56.22±13.00 <.0001
Motility(%) 52.83±12.96 56.44±17.73 .5748 50.14±10.99 57.35±17.05 .1251
Normalmorphology(%) 29.52±13.69 43.59±15.24 .0265 27.06±10.97 40.31±13.67 .0072
Table 5. Pre- and postoperative semen parameters in study groups.
Abbreviations: LV, laparoscopic varicocelectomy; MV, microsurgical subinguinal varicocelectomy.
TMSCImprovedSubgroup(n=19) TMSCUnchangedSubgroup(n=7)
Parameters
Preoperative Postoperative PValue Preoperative Postoperative PValue
TMSC(million) 58.91±14.47 96.27±16.37 <.0001 69.50±15.22 89.81±18.03 .0419
CA-PSV(cm/s) 11.21±5.36 9.24±2.74 .1623 10.36±4.92 9.77±2.81 .7876
CA-PI 1.11±0.19 0.90±0.15 .0006 1.01±0.19 0.92±0.13 .3214
CA-RI 0.60±0.08 0.54±0.07 .0188 0.60±0.08 0.55±0.07 .2371
ITA-PSV(cm/s) 7.17±1.46 6.60±1.09 .1811 7.09±1.33 6.77±1.23 .6486
ITA-PI 0.96±0.15 0.70±0.16 <.0001 0.91±0.15 0.76±0.10 .0480
ITA-RI 0.57±0.09 0.51±0.06 .0208 0.54±0.09 0.51±0.05 .4557
Table 6. Correlation between pre- and postoperative TMSC and ipsilateral CDFI parameters.
Abbreviations: TMSC, total motile sperm counts; CDFI, Color Doppler Flow Imaging; EDV, end diastolic velocity; PI, pulsatility index; PSV, peak systolic velocity; RI,
resistive index; CA, capsular artery; ITA, intratesticular artery.
Varicocelectomy Affects Testicular Supply-Zhang et al
Vol 11. No 05 Sept-Oct 2014 1903
5. ipsilateral CA and ITA were accordingly unchanged (P >
.05). In both subgroup, the values of PSV of CA and ITA
were insignificantly decreased (P > .05).
DISCUSSION
Varicocele is a commonly encountered disease in urology
clinic. Doppler is not only helpful for the diagnosis of
varicocele, but also can monitor the changes of testicular
blood flow parameters before and after varicocelectomy.
(10-12,14,16,17)
The arteriovenous system of the testis is highly
complex and under a fine regulation to maintain a proper
spermatogenesis environment. The testicular, deferential
and cremasteric arteries all provide the blood supply to
the testis, and they form numerous anastomoses at the up-
stream of testicular parenchyma. At this point, they can
not directly reflect testicular microcirculation but CA and
ITA, which locate just in the capsule surface and deep
parenchyma of the testis respectively, are more reliable.
Normally pampiniform plexus can not only take away
testicular metabolic waste but also play a role in cool-
ing the arterial blood before it reaches the testis, helping
ensure the organ stays at the proper temperature, yet the
drainage and cooling function are impaired when varico-
cele arises. Varicocelectomy can partly restore the innate
function of plexiform plexus in order to rectify the testic-
ular microcirculation.(9,18)
Animal studies have shown indeterminate changes in tes-
ticular blood flow in association with varicocele. Li and
colleagues demonstrated a decrease in testicular blood
flow in rats after experimentally induced varicocele;(19)
Ozturk and colleagues indicated that artificial varicocele
induced by partial stenosis of the ipsilateral renal vein
has no effect on testicular blood flow of both sides as
determined by flow cytometry;(20)
while others showed
that testicular blood flow increased after the creation of
experimental varicocele in dogs and rats and returned
to baseline levels after varicocelectomy in rats.(21)
This
discrepancy may be partly explained by methodological
differences in blood flow measurement and the durations
of the created varicocele. Furthermore, experimentally
induced varicocele models in animals are not completely
identical to human, especially regarding different effects
of gravity between human bipedalism and animal quadru-
pedalism.
Several clinical studies have investigated the effects
of varicocele on testicular blood flow. Tarhan and col-
leagues reported that blood flow in varicocele bearing
testicles is less abounded than normal control in men;(22)
Akcar and colleagues reported that subclinical varicocele
does not affect the intratesticular arterial RI,(14)
and Ünsal
and colleagues proved that increased RI and PI values of
CA on spectral Doppler examination are indicators of im-
paired testicular microcirculation in patients with clinical
varicocele.(17)
Concerning varicocelectomy, Sun and col-
leagues used Doppler to investigate the changes in testic-
ular perfusion following laparoscopic varicocele clipping
in children and reported no significant change. However,
they examined only the magnitude of arterial perfusion,
and did not use any arterial flow parameters (PSV, EDV,
RI, and PI) reflecting arterial flow hemodynamics.(23)
Tanriverdi and colleagues compared microsurgery and
high ligation varicocelectomy by evaluating intratestic-
ular arterial flow by CDFI seven days after surgery, and
reported no statistically difference between the preopera-
tive and postoperative RI values in both groups.(16)
A sim-
ilar study comparing two laparoscopic surgical methods
at 3 months follow-up demonstrated that mean RI value
in the group of patients with spermatic artery ligation was
comparable to the group of spermatic artery preservation.
(24)
Most importantly, Balci and colleagues first evaluat-
ed the long term effects of varicocelectomy on testicular
blood flow. In their research, 26 infertile patients with left
varicocele were operated and monitored up to the sixth
month after the operation, though only ITA was evaluat-
ed and the microsurgical varicocelectomy technique was
not applied. They found that the mean EDV value was
increased, the RI and PI values were decreased, and the
PSV value was unchanged after surgery.(12)
Three years
after Balci’s study, Tarhan and colleagues observed the
effects of microsurgical inguinal varicocelectomy (not
MV) on testicular blood flow.(10)
Their results showed that
within six months after surgery the mean PSV and EDV
of left TA increased, and RI and PI values of left CA and
ITA decreased. No significant difference was detected
between the preoperative and postoperative blood flow
parameters in the right TA, CA and ITA. They believed
that PSV and EDV values showed flow velocity; RI and
PI values showed resistance against blood flow, so they
assumed that the blood flow into the ipsilateral testis in-
creased and the resistance against blood flow in affected
testis decreased after surgery. Therefore they concluded
that the PSV and EDV values increase in TA and the PI
and RI values decrease in CA and ITA, and they were the
indicators of an increase in testicular arterial blood flow
into the testicular tissue.
Our study is a prospective case-controlled cohort study,
and initially intended to investigate the long term changes
on the testicular microcirculation before and after laparo-
scopic varicocelectomy using CDFI in adults, however,
surgical techniques evolve over time, subsequently an
added purpose was to compare the two surgical tech-
niques. For the first purpose, we found from the our re-
sults that the values of RI, PI and PSV in the left ITA and
CA decreased within six months after surgery, which was
similar to Tarhan’s report.(10)
Smaller RI and PI values
reflect that arterial resistance of ipsilateral testis decreas-
es after surgery, and smaller PSV values does not sim-
ply mean ipsilateral testicular blood supply decrease, but
should be a self-regulation of preload due to the lighten
afterload. As hemodynamic changes involving the cap-
illary bed and/or venous drainage have direct effects on
arterial impedance,(25)
we infer that hydrostatic pressure
(afterload) of affected testicular venous column decrease
after pampiniform plexus is cleared.(10,12,17)
The self-reg-
ulation must be gradually completed over PODs, so we
have reason to believe that PSV and EDV values of CA
and ITA would increase at the early postoperative period
(within POD7 or POD30?) , then more such data are need
in future. For the second purpose, our case-matched data
demonstrate that MV is superior to LV based upon our
limited CDFI data. The superiority is not caused by the
learning curve though MV is performed posterior to LV
as the surgeon (ZL) has passed the learning curve (> 20
years experiences), but mainly due to the surgical tech-
niques. We suppose that the application of magnification
make the microanatomy of spermatic cord sharper, and
Varicocelectomy Affects Testicular Supply-Zhang et al
Sexual Dysfunction and Infertility 1904
6. the high-definition operative field is positive to a better
postoperative outcome. The microsurgical technique (in-
guinal or subinguinal) is an innovative technique that al-
lows the ligation of all of the veins except the vasal vein
while sparing the local arteries and lymphatics, and is
proved to reduce the recurrence rate and complications.(26)
The subinguinal approach (MV) does not incise the exter-
nal oblique aponeurosis, reducing pain for the patient, but
at the expense of the increased number of veins that must
be ligated.(7)
As such, MV is considered the gold-standard
technique for varicocelectomy in adults.
Semen evaluation is not a principle index in our study,
and infertility is neither our target illness, because merely
less than half participants accepted this test. In the present
study, only semen samples on two time points were col-
lected, so correlation analysis between semen and CDFI
parameters can not be quantified. Moreover, if we divide
such handful of patients into four subgroups according to
the surgical approaches multiply by semen improvement,
the numbers of individual subgroups will be too small,
thus meaningless for further statistical analyses. These are
all limitations of our study. Even though, we can develop
the trend that semen parameters are improved after vari-
cocelectomy (LV or MV), which is in agreement with the
majority of previous reports.(2,3,10,12)
Besides, the values of
PI and RI of ipsilateral CA or ITA seem negative cor-
related with sperm quality, which is also in accord with
others.(10-12)
Although the majority of patients achieved an
improved TMSC, no couple achieved spontaneous preg-
nancy within the follow-up in either group, which is pos-
sibly because of the limited patient number and relative-
ly short observation interval. Additionally, the maximal
improvements in the CDFI parameters appeared as early
as the 3rd month in MV group, while on the 6th month
in LV group. This finding can partly explain Al Bakri’s
report that the sperm quality improves by 3 months after
MV and then does not improve further.(27)
As logically,
if couples plan to receive intrauterine insemination or in
vitro fertilization/intracytoplasmic sperm injection after
correcting the male factor infertility associated with a
varicocele, the efficient surgical approach for varicocele
repair is MV rather than LV.
CONCLUSION
In conclusion, varicocelectomy (either LV or MV) results
in a significant decrease in the values of PSV, PI, or RI
of ipsilateral ITA or CA, and an improvement in semen
parameters in left clinical varicocele patients, which sug-
gests an improvement of the testicular blood supply or
sperm quality. The values of RI and PI of ITA and CA
will be two important indexes for the prognosis after var-
icocelectomy. MV has advantage to LV on postoperative
CDFI parameters, and the former can advance an early
and a more obvious promotion than the latter. Because
the present study covered only a 6-month follow-up pe-
riod, further studies in larger series, longer periods and
with more time points are needed to test the relationship
between testicular perfusion and sperm parameters after
different varicocelectomy approaches.
ACKNOWLEDGEMENTS
This study is granted by the Postgraduate Research Fund
of Qingdao University belonging to Professor Shibao
Fang, Department of Ultrasound, Affiliated Hospital of
Qingdao University and the author (MZ).
CONFLICTS OF INTEREST
None declared.
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