1. Varicocele is an abnormal dilation of the veins within the spermatic cord that represents the most common cause of male infertility.
2. Varicoceles are present in 15-81% of men with infertility and are associated with declining testicular function over time due to elevated temperature and impaired blood flow.
3. Treatment involves ligating or occluding the dilated veins, with options including open or laparoscopic retroperitoneal approaches, inguinal or subinguinal approaches, and radiographic embolization techniques.
Disclaimer: A lot from this slides were taken also from https://www.slideshare.net/babysurgeon/scrotal-swellings-1 (Dr Selvaraj Balasubramani)
This covers only :
ANATOMY
CAUSES
TORSION OF TESTIS
EPIDIDYMO-ORCHITIS
HYDROCELE
EPIDIDYMAL CYST
VARICOCELE
URETHRAL INJURY- Trauma Surgery
#surgicaleducator #babysurgeon
Dear viewers,
Greetings from “Surgical Educator”
Today I have uploaded a video on URETHRAL INJURY- one more in Trauma Surgery. I haven’t talked elaborately but have included the essential minimum an undergraduate medical student should know. I have talked about anatomy, classification, etio-pathogenesis, symptoms, signs, investigations, grading, treatment, complications, treatment algorithm and case vignettes of urethral injuries. My aim is, after watching this video all of you should be able to arrive at a correct working diagnosis of the type of urethral injury and should also be able to institute immediate treatment to the patients if there is a need. The definitive urethroplasty should be done by a Urologist. You can watch the video in the following links:
surgicaleducator.blogspot.com
youtube.com/c/surgicaleducator
Thank you for watching the video.
Types of Urethral injury, Mechanism of Urethral injury, Classification of Urethral injury, Symptoms of Urethral injury, Signs of Urethral injury,
Investigations for Urethral injury, Grading of Urethral Injury, Treatment for Urethral injury, Complications of Urethral Injury
Rectal prolapse (Surgical anatomy of rectum, pathology and management0sunil kumar daha
Please find the powerpoint on Rectal prolapse. I tried present it on understandable way and all the contents are reviewed by experts and from very reliable references.
Disclaimer: A lot from this slides were taken also from https://www.slideshare.net/babysurgeon/scrotal-swellings-1 (Dr Selvaraj Balasubramani)
This covers only :
ANATOMY
CAUSES
TORSION OF TESTIS
EPIDIDYMO-ORCHITIS
HYDROCELE
EPIDIDYMAL CYST
VARICOCELE
URETHRAL INJURY- Trauma Surgery
#surgicaleducator #babysurgeon
Dear viewers,
Greetings from “Surgical Educator”
Today I have uploaded a video on URETHRAL INJURY- one more in Trauma Surgery. I haven’t talked elaborately but have included the essential minimum an undergraduate medical student should know. I have talked about anatomy, classification, etio-pathogenesis, symptoms, signs, investigations, grading, treatment, complications, treatment algorithm and case vignettes of urethral injuries. My aim is, after watching this video all of you should be able to arrive at a correct working diagnosis of the type of urethral injury and should also be able to institute immediate treatment to the patients if there is a need. The definitive urethroplasty should be done by a Urologist. You can watch the video in the following links:
surgicaleducator.blogspot.com
youtube.com/c/surgicaleducator
Thank you for watching the video.
Types of Urethral injury, Mechanism of Urethral injury, Classification of Urethral injury, Symptoms of Urethral injury, Signs of Urethral injury,
Investigations for Urethral injury, Grading of Urethral Injury, Treatment for Urethral injury, Complications of Urethral Injury
Rectal prolapse (Surgical anatomy of rectum, pathology and management0sunil kumar daha
Please find the powerpoint on Rectal prolapse. I tried present it on understandable way and all the contents are reviewed by experts and from very reliable references.
Small intestine/Intestinal obstruction/crohns disease/ileostomy/viscous organ...RajeevPandit10
all about small intestine, anatomy, physiology, intestinal obstruction, crohns disease/ileostomy/viscous organ perforation, meckels diverticulum, mysenteric ischemia, short bowel syndrome, celiac disease
easy description of common lut disorders. improvements on the slides accepted. text includes congenital and acquired disorders. more so the causes of bladder outlet obstructions. also management of the disorders are breifly described.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
Varicocele
1.
2.
3. Varicocele is an abnormal dilation & tortuosity of the internal spermatic
veins within the pampiniform plexus of the spermatic cord.
• Represents the most
common cause of primary
& secondary infertility in
the male.
• Varicoceles are present in 15% of normal males, 19% to 41% in men
with primary infertility,& up to 81% of men with secondary infertility.
4. • Turbulent venous flow related to the insertion of the gonadal veins;
either the left gonadal with a right angle into the left renal vein or the
right gonadal directly into the IVC.
• Incompetent or absent venous valves
in the gonadal veins allow retrograde
reflux of blood into the scrotum on
standing.
• The “nutcracker phenomenon” as the
left renal vein may be compressed
between the superior mesenteric artery
and the aorta.
5. • The Presence of varicocele has a
genetic background which is not
necessarily related to the severity
of the disease
• Varicocele in adolescents is
associated with thin tall body
habitus
• 90% of varicoceles are presented
on the left side while the presence
of large right side varicocele
especially un-decopressible may
indicate retroperitoneal or caval
pathology such as renal
neoplasms.
6.
7. • Varicocele is associated with a progressive and duration-dependent
decline in testicular function.
1. Elevated intrascrotal temperature resulting in reductions in
testosterone synthesis by Leydig cells, injury to germinal cell
membranes, altered protein metabolism, & reduced Sertoli cell
function.
2. The free reflux of renal and adrenal metabolites from the left renal
vein are directly gonadotoxic.
3. Impaired venous drainage results in hypoxia, poor clearance of
gonadotoxins, and elevated levels of oxidative stress.
8.
9. • Despite having a congenital background it is not diagnosed before the
age of 10 years.
• Grade I: Small, detectable only during the Valsalva maneuver.
• Grade II: Moderate, can be palpated without Valsalva.
• Grade III: Large, visible through the scrotal skin & classically
described as feeling like a “bag of worms”, & decompresses in supine
position.
• Sub-Clinical Varicoceles are those not detected clinically but
diagnosed only detected by ultrasonography with or without doppler,
radionucleotide scans, thermography & venography.
11. • Although clinical varicoceles do not require confirmation with
ultrasound examination, color Doppler ultrasound may be required
when the clinical examination is difficult.
• Demonstration of reversal of venous blood flow with the Valsalva
maneuver or spermatic vein diameters of 3 mm or greater support the
diagnosis of varicocele.
• Scrotal ultrasound is not recommended for screening for subclinical
varicoceles as repair of these has not been demonstrated to be of
clinical benefit.
12. • Venography of the internal spermatic veins has been used to diagnose
and treat varicoceles
• Although nearly 100% (Most Sensitive) of clinical varicocele patients
will demonstrate reflux on venographic examination, left internal
spermatic vein reflux has been reported in up to 70% of patients
without a palpable varicocele. (High false positive results & Limited
Specificity)
• It does have utility in patients with presumed post-varicocelectomy
recurrence both for confirmation of the diagnosis and embolization of
persistent vessels.
13.
14. 1. Palpable varicocele on physical examination.
2. Large varicoceles producing clinical symptoms such as dull
hemiscrotal discomfort or sense of heaviness
3. The couple has known infertility with the female partner has
normal fertility or a potentially treatable cause of infertility.
4. The male partner has abnormal semen parameters or abnormal
results from sperm function tests.
5. Adolescent males with unilateral or bilateral clinical varicoceles &
ipsilateral testicular hypotrophy (20% or 3ml volume decrement from
the contralateral testis)
• Patients with subclinical varicoceles are not candidates for varicocele
treatment due to lack of demonstrated efficacy in this population.
• The various methods of varicocele treatment all involve ligation or
occlusion of dilated gonadal veins.
16. • The very 1st approach for varicocele repair employed in the early
1900s
• Involves mass ligation & Excision of the varicosed veins.
• Not preferred practically due to the high incidence of testicular artery
injury with subsequent impairment of the testicular blood supply,
testicular atrophy & more impaired spermatogenesis & fertility.
17. Incision at the level of the internal ring near to the Anterior Superior
Iliac Spine.
Splitting of the External & Internal Oblique Muscles.
Exposure of the Internal Spermatic Artery & Vein retroperitoneaelly
near the ureter where only one or two large veins are present & the
testicular artery is not yet branched & so easy to separate.
High recurrence rate 15% due to preservation of the testicular artery &
the peri-arterial venae comitatntes which communicates with the
larger internal spermatic veins causing recurrence.
Recurrence is prevented by intentional artery ligation, However it
may cause testicular atrophy & subsequent azoospermia.
18. It is an essence retroperitoneal approach with similar advantages &
disadvantages, including rate of recurrence.
The internal spermatic veins are ligated with the laparoscope at the
same level as the retroperitoneal approach with preservation of the
testicular artery.
The magnification provided by the laparoscope allows visualization of
the testicular artery. With experience, the lymphatics may be
visualized and preserved as well preventing secondary hydrocele
formation.
Additional possible complications include visceral & vascular injury,
air embolism & peritonitis.
19. Allows access to external spermatic and gubernacular veins which
causes recurrences if not ligated.
Microsurgical varicocelectomies has resulted in marked decrease in
the incidence of Secondary Hydrocele formation (compared to the
conventional operations with average 7%) due to easy identification of
lymphatics, Plus that identification of testicular artery helps avoiding
azoospermia & atrophy
20. Small Testicular Artery Artery adherent to fascia
Precious Testicular Artery Difficult Opening & Closure of fascia
Better Dissection & fascia Better Exposure & Ligation of veins
Closure
Easier in performance
More Difficult in Performance
21. Incision
• Inguinal: The incision begins at the external
ring and extended laterally 2 to 3.5 cm along
Langer lines.
• Sub-Inguinal: The incision is placed in the
skin lines just below the external ring.
• Camper’s & Scarpa’s Fascia are divided,
Superficial Epigastric Artery or Vein are
retracted or ligated.
22. In the Inguinal Approach
• The External Oblique aponeurosis is opened along the length
of the wound in the direction of its fibers
• Grasping of the spermatic cord & delivery of it through the
wound to be surrounded with a penrose drain after sparing of
the ilioinguinal nerve & genital branch of the genitofemoral
nerve
23. In the Sub-Inguinal Approach
• An index finger is introduced into the
wound and along the cord into the scrotum
then hooked under the external inguinal
ring.
• A Richardson retractor is slid along the
back of the index finger and retracted over
the cord toward the scrotum.
• The spermatic cord will be revealed between the index finger and
retractor, delievered & then surrounded with a large Penrose drain.
24. Dissection of the cord
• The Internal & External Spermatic
fascias are opened & the cord is
inspected for pulsations of the
testicular artery to be dissected
away
• The Cord veins are dissected
starting with the large veins with
taking care of possible adherant
testicular artery (50% Possibility)
25. Dissection of the cord
• All veins are then ligated (except the
vasal veins to allow venous return)
with 4-0 silk ligatures or cauterized
if less than 1 mm.
• After complete dissection only the
testicular artery, cremasteric
arteries, cremasteric muscle fibers,
nerves, lymphatics and vas deferens
with its vessels should remain.
26. Delievery of the Testis
• Delivery of the testis through a small inguinal or subinguinal incision
guarantees direct access to all veins close to the testes
• Assiciated hydrocele (15%) can
alter testicular tempreture
regulation, so should be
repaired if noticed with delivery
of the testis followed by a tube
drain for 24 hours.
27. Special Tools
• The Magnification Microscope with
10-25 power magnification.
• The Micro-Doppler is very useeful for
identifiying the testicular artery.
• The Automatic Clip Applier for
ligation of the veins especially smaller
veins.
28. • Scarpa and Camper fascia are re-approximated with a single or
continuous 3-0 plain catgut suture, and the skin is approximated with a
5-0 monofilament absorbable subcuticular suture.
• A scrotal supporter is applied and stuffed with fluff-type dressings.
• The patient is discharged on the day of surgery with a prescription for
Tylenol with codeine. Light work may be resumed in 2 or 3 days.
29. • Does not prevent recurrence (4% to 11%) but allows visualization of all
collaterals difficult to be seen with the 2D view.
• Drawbacks:
1) Take 1-3 hours to perform compared with 25 to 45 minutes
required for surgical repair.
2) Femoral vein perforation or thrombosis
3) Anaphylaxis to radiographic medium
4) Recurrence with large varicoceles & with Failure to cannulate
small collaterals
5) Migration of the balloon or coil into the renal vein, resulting in
loss of a kidney, pulmonary embolization
30.
31. • The most common complication with incidence 3 -33% (Average 7%).
• With the high protein content proved to be due to lymphatic
obstruction.
• Creates an insulating layer around the testes impairing the efficiency of
the counter-current heat exchange mechanism obviating the benefit of
varicocelectomy.
• The Use of Magnification helps good identification of lymphatics &
preventing hydrocele formation.
32. • The testicular artery forms 2/3 of the blood supply to the testes (with
the vasal & cremasteric arteries form the remaining 1/3).
• Is 1-1.5 mm in diameter, adherent to a large spermatic vein (40% of
men) & Surrounded by a network of tiny veins (20% of men).
• Injury or ligation of the testicular artery carries with it the risk of
testicular atrophy and/or impaired spermatogenesis. (which is less
likely to occur in children due to compensatory neovascularization).
• The Use of Magnification & Micro-Doppler helps good identification &
Preservation of the testicular artery.
33. • The incidence of recurrence after varicocele repair varies from 0.6% to
45%
• Recurrence is mostly associated with:
1. Pediatric Varicocele
2. Non-Magnified Operations
3. Retro-peritoneal approaches (that misses the parallel inguinal
collaterals)
34.
35. • Mean increases in sperm density of 9.7 million/mL, motility
increases of 9.9%, sperm morphology improvement by 3% have
been reported with improvement in semen quality in 51% to 78%
of infertile men.
• About 60% of Azoospermic patients with varicoceles have shown
some potential for return of sperms to their semen after varicocele
repair (Still requiring ART to obtain conception)
36. • Spontaneous pregnancy rates after varicocele treatment have been
reported to average between 30% and 50% within about 8 months
duration.
• Recovery of testicular volume in adolescent patients, so called “catch-up
growth,” has been reported to occur in up to 80% of boys with grade II
or III varicoceles.
• Treatment does not produce improvement in cases with underlying
genetic abnormalities associated with subfertility.