Current management of adolescent varicocele

The finding of varicocele in an adolescent male is common. Varicocele rarely causes symptoms and is often diagnosed on the routine physical examination. There is clear association between varicocele and male factor infertility; however, there is debate about whether, when, and whom to treat when present in adult or adolescent males. This review of the epidemiology, etiology, pathophysiology, and treatment of the adolescent with varicocele will provide the reader with tools to make appropriate decisions in dealing with this condition.     

Regional phlebography in patients with recurrences of varicocele

Diagnostic potentialities of phlebography were studied in 50 patients with varicocele recurrences. Two methods of phlebography: transfemoral renospermaticography and transscrotal orthograde testiculophlebography--were employed. The main cause of recurrence development was shown to be the abnormality of venous outflow from the testicle in the region of the left renal vein, testicular vein and in the pelvic veins. The effectiveness of both methods was 71.9 and 94.4%, respectively, their combined use provided additional information.     

Optimization of radiosurgical treatment for varicocele

The topographic radiological anatomy of the left internal spermatic vein was studied in 95 patients with varicocele, of them 76 had secondary impaired spermatogenesis. Recurrent varicocele after Ivanissevich's operation was observed in 23 patients. The left internal spermatic vein has been found to empty as one trunk into the renal vein in 97.8% of cases. The renal capsular vein always falls into the proximal segment of the left internal spermatic vein. Intersystemic overflows, if present, also empty into the latter. A unified procedure for double-level occlusion of the left internal spermatic vein is described. The proposed procedure was used to operate on 46 patients. Long-term results were studied in periods of 3 months to 2 years. Recurrent varicocele was not revealed.     

Ultrasound biomicroscopy for longitudinal studies of carotid plaque development in mice: validation with histological endpoints

Atherosclerosis is responsible for the death of thousands of Americans each year. The carotid constriction model of plaque development has recently been presented as a model for unstable plaque formation in mice. In this study we 1) validate ultrasound biomicroscopy (UBM) for the determination of carotid plaque size, percent stenosis, and plaque development in live animals, 2) determine the sensitivity of UBM in detecting changes in blood flow induced by carotid constriction and 3) test whether plaque formation can be predicted from blood flow parameters measured by UBM. Carotid plaques were induced by surgical constriction in Apo E−/− mice. Arteries were imaged bi-weekly by UBM, at which time PW-Doppler measurements of proximal blood flow, as well as plaque length and percent stenosis were determined. Histology was performed 9 weeks post surgery. When compared to whole mount post-mortem measurements, UBM accurately reported carotid plaque length. Percent stenosis, based on transverse B-mode UBM measurements, correlated well with that calculated from histological sections. PW-Doppler revealed that constriction reduced maximum systolic velocity (v_max) and duration of the systolic velocity peak (t_s/t_t). Pre-plaque (2 week post-surgery) PW-Doppler parameters (v_max and t_s/t_t) were correlated with plaque length at 9 weeks, and were predictive of plaque formation. Correlation of initiating PW-Doppler parameters (v_max and t_s/t_t) with resulting plaque length established the degree of flow disturbance required for subsequent plaque development and demonstrated its power for predicting plaque development.     

Inhibition of testicular testosterone biosynthesis following experimental varicocele in rats

In an attempt to determine whether defective testicular testosterone (T) biosynthesis may be associated with a varicocele, an experimental study was performed in adult rats whereby a unilateral left varicocele was surgically created. At 2, 4, 8, and 12 wk following the creation of the varicocele, intratesticular T as well as the activities of three (17 alpha-hydroxylase, 17,20-desmolase, and 17 beta-hydroxysteroid dehydrogenase) of the five enzymes in the delta 4 pathway of testicular T biosynthesis were measured. Intratesticular T (ng/g testis +/- SEM) in the left testis decreased significantly from 121 +/- 21 in the control group to 59 +/- 8 in the two-wk varicocele group (p less than 0.01), and remained significantly suppressed throughout the experimental period. The T concentrations in the right testis paralleled those in the left in both the control and varicocele animals. At 2 wk following the creation of the varicocele, the activity (nmol/min/testis +/- SEM) of the 17,20-desmolase enzyme decreased significantly, from 115 +/- 8 in the left testis of control rats to 87 +/- 6 in the left testis of the varicocele animals (p less than 0.025), and remained low throughout the 12 weeks of the study. The activity of the 17 alpha-hydroxylase enzyme was significantly decreased at the 8th and 12th weeks of the study, while the 17 beta-hydroxysteroid dehydrogenase activity did not show any significant change during the study period. The enzyme activities in the right testis paralleled those in the left testis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Beneficial effects of varicocele embolization on semen parameters

The suffering caused by infertility in a man can have multiple aspects. It can display a narcissistic dimension, an objectal dimension (object-libido) turned toward others or/and an identity dimension. Two clinical case reports were used here to (i) illustrate all these aspects of infertility suffering, (ii) to evidence the difficulty for infertile men to speak about their infertility and (iii) underlie the importance for professional of medical assisted reproduction to be attentive to this suffering that many men keep silent. An empathetic attention to infertile men may give a way to express this suffering and thus allow the beginning of a psychoanalytic approach which is necessary in infertility and especially for infertile men who do not easily express their suffering.     

腹腔镜精索静脉曲张高位结扎250例报告

目的:探讨腹腔镜精索静脉曲张高位结扎治疗精索静脉曲张的疗效与安全性.方法:回顾性分析行腹腔镜精索静脉曲张高位结扎250例患者的临床资料.结果:250例手术均成功,术后随访平均1年,无一例复发.结论:该术式对患者损伤小,恢复快,疗效确切,并发症少,特别适用双侧精索静脉曲张.     

Color Doppler sonography of normal male genitalia and varicocele

The present paper reports on the results of complex sonographic examination of scrotum organs in 116 patients. The study was performed with Siemens sonographic unit. According to clinico-laboratory data and results of operative intervention, the patients were divided into two groups. The 1st group (8 persons) had no pathology in the scrotum organs, the 2nd group (98 patients) had diagnosis of varicocele. In norm capsular, centripetal and transmeridian arteries were visualized in the projection of testis in colour Doppler sonography. Resistancy index was measured. The group with varicocele in colour Doppler sonography with Valsalva test showed a prolonged retrograde wave of blood flow during the whole period of tension. To determine the stage of pathologic process, a scale system had been used. Doppler sonography enables to reveal various types of reflux. The character of reflux determines a pathogenetic cause of varicocele that effects on the choice of the method of operative intervention. Parameters of colour Doppler sonography allow to determine the stage of the disease and reveal subclinical varicocele in cases when pampiniform plexus is absent, but significant hemodynamic changes take place. The data of Doppler sonography have been confirmed by the results of operative intervention.     

Ultrasound hemolysis

An ultrasound unit for hemolysis for an analytic device is presented which permits hemolysis without the need of a specific insonification chamber which is an unwanted discontinuity along the probe path. This is possible by direct insonification of a flexible tube which contains the flowing blood. The influence of ultrasound power, insonification time and coupling conditions on the result of hemolysis is investigated.     

Ultrasound imaging

Modern ultrasonic transducers mainly employ lead zirconate titanate (PZT) but vinylidene fluoride trifluoroethylene copolymer (P (VDF-TrPE)) is becoming more competitive. The static scanner is now largely replaced by mechanical or electronically controlled array real time systems; the speed of scanning is limited by the speed of sound and the resolution depends on the wavelength and so, ultimately, on the attenuation in tissue. Tissue inhomogeneities degrade the resolution. Intraoperative and intracavitary scanners have advantages in some anatomical situations and ultrasonic imaging can guide extracorporeal shock wave lithotripsy. Inexpensive battery powered scanners will soon become available. Duplex scanners are used to localize the acquisition of Doppler signals; blood flow volume rate can be estimated from measurements of blood velocity and vessel cross-sectional area, or by the attenuation-compensated technique which avoids the main sources of error. Colour flow mapping combines real time imaging with Doppler information, but has limited scanning speed. Computed tomography and acoustical microscopy are feasible. Speckle arises from the coherent nature of ultrasound and can be suppressed by summing uncorrelated images or by filtering. Image manipulation and display techniques are being developed to cope with three dimensional scan data and the approach is compatible with picture archiving and communication systems (PACS). Tissue characterization based on the measurement of properties has been disappointing but blood flow analysis and contrast agents are promising. Quality assurance programmes are crucial; ultrasonic diagnosis appears to be free from hazard and prudent use is determined by cost-benefit considerations.