[Ultra-remote robot-assisted laparoscopic surgery for varicocele through 5G network: Report of two cases and review of the literature].

OBJECTIVE: At present, the longest network transmission distance (NTD) for 5G remote endoscopic surgery is reportedly only about 229 km, and the NTD longer than 5 000 km has not yet been reported in clinical application. In this study, we attempted the clinical application of 5G ultra-remote robot-assisted laparoscopic surgery in spermatic vein ligation. METHODS: This retrospective study included two cases of 5G ultra-remote robot-assisted laparoscopic spermatic vein ligation using the home-made Tumai Surgical Robot System. The operation table was located in Xinjiang Kezhou People's Hospital, with an NTD of about 5 800 km (a linear distance of about 3 800 km) from the surgeon's console in the Telemedical Center of the First Affiliated Hospital of Nanjing Medical University, the apparatuses connected through the public 5G network. We observed the network connection delay, network fluctuation, and data packet loss rate of the devices at both ends of the loop through the feedback value of the Ping command by real-time monitoring. RESULTS: The total operation time of the two cases was 45 and 40 minutes respectively, with a mean blood loss of < 5 ml. The patients resumed a liquid diet and out-of-bed activity on the first day, the abdominal drainage tubes removed on the second, and both discharged from the hospital on the third day. The intraoperative average two-way network delay was 130 ms, and the average continuous data packet loss rate was 1.4%. No adverse network events, such as network interruption, occurred during the operation. CONCLUSION: Through the public 5G network and home-made Tumai Surgical Robot System, ultra-remote robot-assisted laparoscopic surgery was performed safely and successfully.

With a new clip technique surgically inducing varicocele in Sprague-Dawley rats.

BACKGROUND: We introduced and recreated a more consistent and effective experimental varicocele rat model by a new clip technique. METHODS: A total of 40 rats were numbered and randomly assigned to 5 groups of 8 each, including sham surgery (Group I), conventional (Group II) and clip groups with 0.7, 0.8, 0.9 mm gap widths, respectively (Group III, IV, V). All of the rats in each group were sacrificed at 8 weeks after initial surgery, and the rats forming out with less than 1 mm diameter of left spermatic vein or no presence of the pampiniform plexus dilation were excluded from the experimental groups. The left spermatic vein (LSV) diameter, testicular weight, left kidney weight to body weight coefficients, kidney and testicular histology were determined. RESULTS: The baseline mean diameter of the LSV in Group I, II and III was 0.22 ± 0.02, 0.23 ± 0.02 and 0.22 ± 0.03 mm, respectively (P = 0.7504). At 8 weeks after initial surgery, varicocele was successfully created in 6/8 (75%), 7/8 (87.5%), 3/8 (37.5%), 3/8 (37.5%) in GroupII-V, no varicocele was observed in Group I. In Group I, II and III, no pathological changes were observed and the left kidney weight to body weight coefficients showed no significant differences. The diameter of LSV was remarkably increased both in Group II and III compared to Group I (1.72 ± 0.13, 1.57 ± 0.19 and 0.25 ± 0.02, respectively), and Group II and III had a smaller testicular weight than the rats in Group I (1.67 ± 0.05, 1.62 ± 0.06, and 1.92 ± 0.12, respectively). CONCLUSIONS: With a new clip technique, surgically inducing varicocele rat model becomes convenient and safe. This appears to improve the effectiveness of the model and this innovation may allow us to further understand the pathophysiology of varicocele.

Ultrasonography assessment of spermatic vein thrombosis.

There are few clinical problem of spermatic vein thrombosis were reported. Spontaneous spermatic vein thrombosis is a particularly rare diseases which can lead to acute or chronic testicular pain and testicular swelling. We report a case in which ultrasonography (US) discovered hypoechoic mass of left spermatic vein and contrast-enhanced ultrasonography (CEUS) revealed thrombus formation of left spermatic vein in a patient who had underwent a continuous driving for eight hours twenty days ago.

Varicocele is the root cause of BPH: Destruction of the valves in the spermatic veins produces elevated pressure which diverts undiluted testosterone directly from the testes to the prostate.

In varicocele, there is venous flow of free testosterone (FT) directly from the testes into the prostate. Intraprostatic FT accelerates prostate cell production and prolongs cell lifespan, leading to the development of BPH. We show that in a large group of patients presenting with BPH, bilateral varicocele is found in all patients. A total of 901 patients being treated for BPH were evaluated for varicocele. Three diagnostic methods were used as follows: physical examination, colour flow Doppler ultrasound and contact liquid crystal thermography. Bilateral varicocele was found in all 901 patients by at least one of three diagnostic methods. Of those subsequently treated by sclerotherapy, prostate volume was reduced in more than 80%, with prostate symptoms improved. A straightforward pathophysiologic connection exists between bilateral varicocele and BPH. The failure of the one-way valves in the internal spermatic veins leads to a cascade of phenomena that are unique to humans, a result of upright posture. The prostate is subjected to an anomalous venous supply of undiluted, bioactive free testosterone. FT, the obligate control hormone of prostate cells, reaches the prostate directly via the venous drainage system in high concentrations, accelerating the rate of cell production and lengthening cell lifespan, resulting in BPH.

Reproductive hormones and sperm parameters after varicocele repair: An observational study.

Varicocele repair (VR) is associated with improved sperm parameters in subfertile patients. We examined the association of the levels of reproductive hormones, scrotal colour Doppler ultrasound (CDU) and seminal parameters in subfertile men, before and after VR. Fifty subfertile males, with left-side varicocele, were enrolled in this retrospective study. The serum levels of FSH, LH and total testosterone (TT), along with continuous left spermatic venous reflux (SVR) and testicular volumes at CDU were evaluated, before and six months after VR by a left-side retrograde internal spermatic vein sclero-embolisation (SVE). Left-side SVR was either no longer present or significantly reduced in all patients after VR (p < 0.0001). Sperm parameters, in particular, the total sperm motile count (TMC), were found significantly improved after VR (p < 0.0001). Post-VR, no differences were observed in the baseline values of the reproductive hormones. Only SVR change was seen to predict TMC change (p = 0.026) in the univariate analysis, while reproductive hormones change had no effect on TMC change (FSH:p = 0.85;LH:p = 0.44;TT:p = 0.76). In conclusion, the improved sperm parameters were associated with the disappearance or reduction in SVR and not with changes in the levels of reproductive hormones after SVE. Thus, SVR change at CDU was the only predictor of improved sperm quality after VR in subfertile males.

Benign Prostatic Hyperplasia: Long-term follow-up of prostate volume reduction after sclerotherapy of the internal spermatic veins.

The purpose was to examine the results of bilateral percutaneous sclerotherapy of the internal spermatic veins on prostate volume and prostatic symptoms. We previously showed that destruction of one-way valves in the internal spermatic veins (varicocele) elevates hydrostatic pressure in the vertical testicular venous drainage system in the erect human. This diverts free testosterone (FT) flow at high concentrations directly from the testes into the prostate. High intraprostatic FT prolongs prostate cell life and increases cell proliferation rate-synergistic effects resulting in increased cell population (BPH). Treatment by interventional radiology (or microsurgery) techniques eliminates this diversion of FT flow to the prostate and reverses these pathologic processes. A total of 206 BPH patients with varicocele underwent bilateral sclerotherapy of the ISV. Of these, 81.5% exhibited significantly reduced prostate volume and improvement in prostatic symptoms (measured by IPSS scores) during follow-up period of 12 to over 24 months. 8% went on to require surgery despite mild post-treatment improvement (TURP). The use of prostate medications along with the treatment may have a combined positive effect. Very large prostate volume and large residual volume may limit degree of improvement. It is concluded that effective treatment of varicocele restores normal supply of testosterone to the prostate solely via its arterial supply, resulting in significant decrease of prostate volume and prostatic symptoms. The procedure is safe with only minor transient side effects.

Determination of spermatic vein reflux after varicocele repair helps to define the efficacy of treatment in improving sperm parameters of subfertile men.

PURPOSE: A continuous spermatic venous reflux (SVR) at colour Doppler ultrasound (CDU) is an evidence for varicocele, a frequent correlate for male subfertility. We explored whether SVR after left varicocele repair is predictive for changes in semen quality in subfertile men. METHODS: Blood hormones (FSH, LH, and total testosterone) and scrotal CDU were obtained in subfertile patients with left grade II or grade III varicocele on physical evaluation and a poor sperm quality. Semen analysis and CDU were re-evaluated 6 months after a retrograde internal spermatic vein scleroembolisation. RESULTS: The retrospective study included 100 men with a baseline SVR >3 cm/s; 60 men showed a disappearance (group 1) and 40 men (group 2) showed a reduced SVR after varicocele repair. Total motile sperm count (TMC) was markedly increased after treatment (p < 0.0001; F = 35.79) and the increase was more relevant in group 1 compared to group 2 (p = 0.04; F = 4.20). TMC and left SVR values after varicocele repair were negatively correlated (R = -0.218; p = 0.035). Multivariate analysis showed that adjusted SVR after repair negatively predicted TMC change (TMC after repair minus baseline TMC) (ß = -2.56; p = 0.022). Disappearance of a continuous left SVR at CDU after varicocele repair was associated to a better improvement of semen parameters in subfertile men. CONCLUSION: Recording of a continuous left spermatic vein reflux is an objective method to assess a successful varicocele repair aimed to improve sperm parameters in subfertile men.

[Correlation between anatomical factors of spermatic vessels and varicocele].

Objective: To analyze the correlation between anatomy of spermatic vessels and varicocele, providing reference for the preoperative assessment and treatment of varicocele. Methods: A total of 156 patients who underwent microsurgical left subinguinal varicocelectomy at Shanghai General Hospital between May 2015 and July 2016 were included in this study. The severity of varicocele and number of spermatic vessels detected in operations were recorded. According to the number of internal spermatic arteries (ISAs), the patients were divided into three groups: single-ISA group (55 cases), double-ISAs group (63 cases) and multi-ISAs group (38 cases), to analyze the correlation among spermatic vessels and to compare varicocele grade, the volume of testes, the parameter of semen analysis, serum reproductive hormone, surgery time, and hospital stay among the three groups. Results: The number of ISAs was positively correlated with the ipsilateral internal spermatic veins (ISVs) (r=0.210; P=0.008)and lymphatic vessels (r=0.224; P=0.005); the number of lymphatic vessels was positively correlated with the ipsilateral gubernacular veins (r=0.172; P=0.032)and ISVs (r=0.296; P=0.000) . The number of ISVs in the multi-ISAs group (10.58±4.28) was significantly larger than that in the single-ISA group (8.22±3.10, P=0.003). The number of lymphatic vessels in the multi-ISAs group(4.11±1.90)was also significantly larger than that in the double-ISA group(3.76±1.40, P=0.020) and the single-ISA group(3.13±1.52, P=0.007). The number of ISVs in grade 2 varicocele patients (9.74±3.90) was significantly higher than that in grade 3 varicocele patients (8.33±3.10, P=0.013). No significant differences in varicocele grade, change of pre- and post-operative semen analysis, serum reproductive hormone, the volume of ipsilateral testes, surgery time, and hospital stay were observed among the three groups. Conclusions: There is a correlation among various kinds of spermatic vessels. Patients with grade 2 varicocele, especially who have multiple ISAs, are likely to have more ISVs and lymphatic vessels. For these patients, surgeons should pay more attention to protect spermatic arteries and lymphatics carefully while ligating varicose veins completely to prevent recurrence and complications.

[Microscopic spermatic vein ligation for nutcracker phenomenon complicated with left varicocele].

OBJECTIVE: To investigate the clinical effect of microscopic spermatic vein ligation in the treatment of nutcracker phenomenon (NCP) complicated with left varicocele (VC). METHODS: This retrospective study included 31 cases of NCP complicated with left VC treated in our hospital by subinguinal microscopic ligation of the left spermatic vein (group A, n = 11), open retroperitoneal high ligation of the left spermatic vein (group B, n = 11), or conservative therapy (group C, n = 9). The patients were followed up for 6－24 (15.3 ± 5.4) months. We compared the semen parameters, spermatic vein diameter, left testis volume, and recurrence rate among the three groups of patients before and after treatment. RESULTS: Compared with the baseline, the semen quality parameters were significantly improved in both groups A and B at 6 months after treatment (P<0.05) but reduced in group C (P<0.05); the spermatic vein diameter at rest and that at Valsalva maneuver were markedly decreased in groups A (ï¼»2.53 ± 0.27ï¼½ vs ï¼»1.84 ± 0.22ï¼½ and ï¼»3.53 ± 0.19ï¼½ vs ï¼»2.16 ± 0.25ï¼½ mm, P<0.05) and B (ï¼»2.62 ± 0.33ï¼½ vs ï¼»2.15 ± 0.43ï¼½ and ï¼»3.36 ± 0.25ï¼½ vs ï¼»2.44 ± 0.27ï¼½ mm, P<0.05) but increased in group C (ï¼»2.56 ± 0.28ï¼½ vs ï¼»2.94 ± 0.24ï¼½ and ï¼»3.33 ± 0.21ï¼½ vs ï¼»3.77 ± 0.26ï¼½ mm, P<0.05). No statistically significant differences were found in the left testis volume at 6 months after treatment in group A (ï¼»9.85 ± 1.86ï¼½ vs ï¼»10.27 ± 1.18ï¼½ ml, P>0.05), B (ï¼»9.77 ± 2.03ï¼½ vs ï¼»9.96 ± 1.72ï¼½ ml, P>0.05), or C (ï¼»9.83 ± 1.59ï¼½ vs ï¼»10.48 ± 2.05ï¼½ ml, P>0.05), nor in the recurrence rate between groups A and B (P>0.05). CONCLUSIONS: Hematuria, proteinuria and other mild symptoms of nutcracker phenomenon complicated with left VC can be treated palliatively by microscopic ligation of the spermatic vein, which can relieve the clinical symptoms, improve the semen quality, and protect the testicular function of the patient.

[Microscopic spermatic vein ligation for the treatment of varicocele].

OBJECTIVE: To explore the effect of spermatic vein ligation under the microscope in the treatment of varicocele (VC). METHODS: A total of 120 VC patients received in our department from September 2011 to February 2015 were randomly divided into an experimental and a control group of equal number, the former treated by microscopic spermatic vein ligation and the latter by conventional open high ligation. Comparisons were made between the two groups of patients in the internal diameters of the spermatic vein during eupnea and Valsalva maneuver, the reflux time of the spermatic vein, blood flow parameters of the testicular artery, and semen quality before and at 3 months after surgery. RESULTS: At 3 months after surgery, the experimental group, as compared with the control, showed significantly decreased reflux time of the spermatic vein (ï¼»0.41 ± 0.10ï¼½ vs ï¼»1.08 ± 0.10ï¼½ s, P <0.05) and peak systolic velocity (9.26 ± 1.35 vs 10.64 ± 1.28, P <0.05) and resistance index (0.52 ± 0.03 vs 0.61 ± 0.03, P <0.05) of the testicular artery but markedly increased internal diameters of the spermatic vein during eupnea (ï¼»1.63 ± 0.07ï¼½ vs ï¼»1.59 ± 0.06ï¼½ mm, P <0.05) and Valsalva maneuver (ï¼»1.72 ± 0.05ï¼½ vs ï¼»1.68 ± 0.07ï¼½ mm, P <0.05), sperm concentration (ï¼»46.84 ± 5.24ï¼½ vs ï¼»35.35 ± 4.26ï¼½ ×106/ml, P <0.05), sperm motility (ï¼»63.75 ± 7.73ï¼½ vs ï¼»53.87 ± 6.46ï¼½ %, P <0.05), and total sperm count (ï¼»89.54 ± 7.95ï¼½ vs ï¼»75.24 ± 8.43ï¼½ ×106/ml, P <0.05). CONCLUSIONS: Microscopic spermatic vein ligation has a definite effect in the treatment of varicocele, which can significantly improve the testicular blood flow and semen quality of the patient.

[Microsurgical bypass for varicocele with nutcracker syndrome].

OBJECTIVE: To investigate the clinical effect and feasibility of internal spermatic vein-inferior epigastric vein (ISV-IEV) bypass surgery in the treatment of varicocele complicated by left renal vein nutcracker syndrome (NCS). METHODS: We retrospectively analyzed the clinical data about 30 cases of varicocele with left renal vein NCS treated by ISV-IEV bypass surgery in our hospital from June 2014 to February 2017. We reviewed the follow-up data and results of ultrasonography, routine urianlysis and semen routine examination. RESULTS: All the operations were successfully accomplished and postoperative color Doppler ultrasonography showed that varicocele was cured in all the cases. At 6 months after surgery, sperm concentration and the percentage of grade a+b sperm were significantly improved (ï¼»34.47 ± 8.60ï¼½ ×106/ml and ï¼»63.54% ± 9.58ï¼½ %) as compared with the baseline (ï¼»19.90 ± 8.97ï¼½ ×106/ml and ï¼»37.93 ± 8.73ï¼½ %) (P <0.05). Hematuria was cured in 23 and alleviated in 1 of the 24 cases. Proteinuria disappeared in all the 14 cases, with neither scrotal pain symptoms nor obvious complications. CONCLUSIONS: ISV-IEV bypass surgery, with its advantages of safety, effectiveness, minimal invasiveness, and simple operation, deserves wide clinical application in the treatment of varicocele with left renal vein NCS.

[Correlation of the inner diameter parameters of the spermatic vein in different positions and states of the varicocele patient with the results of seminal examination].

OBJECTIVE: To study the correlation of the inner diameter parameters of the spermatic vein in different positions and states of the varicocele (VC) patient with the results of seminal examination. METHODS: A total of 149 VC patients underwent ultrasonography, routine semen examination, and sperm morphological analysis. The parameters obtained from ultrasonography included the bilateral testis volume in a supine position, the largest spermatic vein diameter in a supine position at rest (DSR), the largest spermatic vein diameter in a supine position following Valsalva manoeuvre (DSV), the largest spermatic vein diameter in an upright position at rest (DUR), and the largest spermatic vein diameter in an upright position following Valsalva manoeuvre (DUV). Then we calculated the parameters △DS=DSV－DSR, △DU=DUV－DUR, △DR=DUR－DSR, and △DV=DUV－DSV and analyzed the correlation of the above parameters with the results of semen examination using the ROC curve. RESULTS: Based on the results of semen examination, 119 (79.87%) of the patients were allocated to the abnormal group and the other 30 (20.13%) to the normal group. Statistically significant differences were observed between the two groups in △DU (P=0.007), △DR (P=0.0001), and △DV (P=0.04), but not in DSR (P=0.35), DSV (P=0.34), DUR (P=0.06), DUV (P=0.12), and △DS (P=0.64), nor in the volume of the testis affected (P=0.323). The area under the ROC curve was 0.55 for DSR, 0.57 for DSV, 0.64 for DUR, 0.62 for DUV, 0.49 for △DS, 0.28 for △DU, 0.86 for △DR, and 0.69 for △DV. The corresponding cutoff values were 2.25, 2.51, 2.48, 2.63, 0.30, 0.23, 0.25, and 0.20, the corresponding sensitivities of semen detection were 50.42%, 65.55%, 60.50%, 60.50%, 49.90%, 29.41%, 79.83%, and 65.55%, and the corresponding specificities were 56.67%, 63.33%, 63.33%, 63.33%, 56.67%, 33.33%, 80%, and 63.33%, respectively. CONCLUSIONS: The difference between the largest spermatic vein diameters in supine and upright positions at rest provides a high diagnostic accuracy for semen detection and helps to predict abnormality in seminal examination for VC patients.

Glutathione-S-transferase-oxidative stress relationship in the internal spermatic vein blood of infertile men with varicocele.

This study aimed to assess glutathione-S-transferase (GST) enzyme- oxidative stress (OS) relationship in the internal spermatic vein (ISV) of infertile men associated with varicocele (Vx). Ninety five infertile oligoasthenoteratozoospemic (OAT) men associated with Vx were subjected to history taking, clinical examination and semen analysis. During inguinal varicocelectomy, GST, malondialdehyde (MDA) and glutathione peroxidase (GPx) were estimated in the blood samples drawn from ISV and median cubital veins. The mean levels of GST, GPx were significantly decreased and the mean level of GPx was significantly increased in the ISV compared with the peripheral blood. The mean level of GST and GPx in the ISV was significantly decreased, and the mean level of MDA was significantly increased in Vx grade III compared with Vx grade II cases. There was nonsignificant difference in the mean level of GST in the ISV in unilateral Vx cases compared with bilateral Vx cases. There was significant positive correlation of GST with sperm count, sperm motility, GPx and significant negative correlation with sperm abnormal forms, MDA. It is concluded that ISV of infertile men associated with Vx has decreased levels of GST compared with peripheral venous circulation that is correlated with both OS and Vx grade.

Assessing safety and efficacy of microscopic and laparoscopic varicocoelectomy for varicocoele treatment: A comparative cohort study.

BACKGROUND: Surgical is appropriate for 35-40% of varicocoele-induced infertility. This comparative observational study presents a comparative assessment of microscopic or laparoscopic varicocoelectomy (grade II varicocoele; n = 132 cases). METHODS: Sperm count, density, total motility, and forward motility rate (preoperative and postoperative 6 months), operation duration, pain at 1 month, testicular atrophy (by scrotal ultrasound at 3 months), recurrence (angiography at 6 months), and scrotal edema (at 12 months) were measured. RESULTS: The preoperative semen parameters were comparable between groups (P > 0.05), as were certain postoperative results (total sperm count [median 162 (range 100-242) compared with median 182 (range 84-253)]; sperm density [median 47 (range 38-83) compared with median 42 (range 27-88)]; forward motility (37.18 ± 4.14 compared with 34.13 ± 7.79); P > 0.05). However, sperm motility was higher in the microscope group (52.79 ± 8.21 compared with 46.64 ± 10.04; t = 2.304, P = 0.040). Within the microscope group, postoperative sperm density [median 47 (range 38-83)], total sperm motility (53.79 ± 8.25), and forward motility sperm rate (37.19 ± 4.14) demonstrated significant improvements compared with preoperative values (Z = -2.679, P = 0.005; t = -4.548, P < 0.001; t = -5.029, P < 0.001). In contrast, the postoperative forward motility sperm rate (34.13 ± 7.78) displayed substantial improvements compared with preoperative values (27.74 ± 14.42) within the laparoscopic group (t = -3.895, P = 0.001). Testicular atrophy occurred in neither group. CONCLUSIONS: Microscopic varicocoelectomy may be safer and more effective.

Anatomic characteristics of the right internal spermatic vein based on imaging analysis: a retrospective study in southwest China.

OBJECTIVE: The specific anatomic characteristics of the right internal spermatic vein (ISV) are pivotal factors in embolism failure. However, the inherent angles and configurations of the right ISV remain incompletely explored. This study aimed to address this gap by conducting a thorough investigation into the specific anatomic characteristics of the right ISV using imaging analysis in southwest China. METHODS: This retrospective study analyzed the imaging data of 1000 male patients who underwent multidetector spiral computed tomography (MCT). Anatomic characteristics of the right ISV, including position, type, distance, and angle, were also evaluated. RESULTS: The most common anatomic type (87.8%) of the right ISV was direct drainage into the inferior vena cava, with 90% of the angles below 25.7°. There were 22 cases (2.2%) with parallel right spermatic veins. In the axial plane, the right ISV (86.4%) was located in the third and fourth quadrants. The diameter at the entrance of the right ISV ranged from 2.7-3.8 mm. When the right ISV drained into the inferior vena cava, 83% of cases were located within 40 mm distance below the ostium of the right renal vein, while during draining into the right renal vein, the average distance from the main vein was 6.3 mm. CONCLUSION: This study concluded that MCT can be used to evaluate the anatomical characteristics of the right ISV. The optimal interventional approach was through the jugular vein route to locate the ISV opening and improve the success rate of the embolization.

The Influence of Number of Ligated Veins in Varicocele Patients Undergoing Microsurgical Varicocelectomy in Postoperative Pain and Sperm Parameters Outcome.

Background: The influence of the number of veins that should be ligated in varicocele surgery on postoperative pain and testicular function is not clearly understood. Objective: The aim of this study was to investigate the number of Internal Spermatic Vein (ISV) ligated in postoperative pain and sperm parameters outcome. Methods: Relevant studies were collected and systematically reviewed from Medline, Scopus, and Cochrane databases. This study followed the PRISMA guideline. The mean difference (MD), odds ratio (OR), and 95% confidence intervals (CIs) were measured in the assessment of the outcome. Revman 5.4 was used in data analysis. Results: The pooled meta-analysis demonstrated that complete pain resolution was significantly higher in patients undergoing varicocelectomy procedures with more than ten vein numbers ligated with OR 1.92, 95% CI (1.03, 3.60). Improvement of sperm parameters of change in sperm concentration was also significantly observed in patients with more than ten vein numbers ligated MD 32.79, 95% CI (23.13, 42.45). However, the number of veins ligated was not associated with the change in sperm motility MD 9.69 with 95% CI (-12.32, 31.71). Conclusion: The number of veins ligated intraoperatively determined pain relief and sperm concentration improvement. This study showed that varicocelectomy results improved with greater ISV ligation.

Spermatic vein thrombosis as a rare cause of testicular pain - review of the literature.

Introduction: The authors in this paper discuss a rare disease entity that can cause testicular pain and mimic varicocele. Material and methods: Citing data from a review of the world literature, spermatic cord thrombosis is most often misdiagnosed as an incarcerated inguinal hernia. Patients usually complain of pain and swelling of the testicle, pain in the inguinal region, and sometimes a palpable mass in the inguinal region. Results: Ultrasonography with colour Doppler usually establishes the correct diagnosis. Currently, there are no official recommendations for the treatment of this disease.There are reports of conservative treatment of spermatic cord thrombosis in the world literature. However, it seems that the gold standard of management remains surgical exploration, which allows us to unequivocally establish the correct diagnosis. In cases of co-morbid thrombosis with spermatic cord varicocelectomy is recommended. Conclusions: Due to the rarity of this disease, the topic of this article was undertaken. The paper reviews the world literature relating to the diagnosis and treatment of this disease entity. Our own algorithm for the management of spermatic cord thrombosis is proposed.

Metachronous bilateral spontaneous spermatic vein thrombosis: A rare cause of orchialgia.

Scrotal pain and swelling are common presentation, the prompt evaluation and diagnosis is needed due to wide range of causes, uncommon causes of orchialgia should be kept in mind whenever there is no clear diagnosis. Spermatic vein thrombosis usually presents with orchialgia along with episodes of acute exacerbation of pain. The diagnosis is challenging and need high index of suspension and detailed radiological evaluation. We present a case of metachronous bilateral unprovoked spermatic vein thrombosis treated conservatively with anticoagulation with good response and resolution of symptoms.

Production of 11-Oxygenated Androgens by Testicular Adrenal Rest Tumors.

CONTEXT: Testicular adrenal rest tumors (TART) are a common complication in males with classic 21-hydroxylase deficiency (21OHD). TART are likely to contribute to the androgen excess in 21OHD patients, but a direct quantification of steroidogenesis from these tumors has not been yet done. OBJECTIVE: We aimed to define the production of 11-oxygenated 19-carbon (11oxC19) steroids by TART. METHODS: Using liquid chromatography-tandem mass spectrometry, steroids were measured in left (n = 7) and right (n = 4) spermatic vein and simultaneously drawn peripheral blood (n = 7) samples from 7 men with 21OHD and TART. For comparison, we also measured the peripheral steroid concentrations in 5 adrenalectomized patients and 12 age- and BMI-matched controls. Additionally, steroids were quantified in TART cell- and adrenal cell-conditioned medium, with and without adrenocorticotropic hormone (ACTH) stimulation. RESULTS: Compared with peripheral blood from 21OHD patients with TART, the spermatic vein samples displayed the highest gradient for 11ß-hydroxytestosterone (11OHT; 96-fold) of the 11oxC19 steroids, followed by 11-ketotestosterone (47-fold) and 11ß-hydroxyandrostenedione (11OHA4; 29-fold), suggesting production of these steroids in TART. TART cells produced higher levels of testosterone and lower levels of A4 and 11OHA4 after ACTH stimulation compared with adrenal cells, indicating ACTH-induced production of testosterone in TART. CONCLUSION: In patients with 21OHD, TART produce 11oxC19 steroids, but in different proportions than the adrenals. The very high ratio of 11OHT in spermatic vs peripheral vein blood suggests the 11-hydroxylation of testosterone by TART, and the in vitro results indicate that this metabolism is ACTH-sensitive.

Comparison of spermatic and peripheral blood gases and their correlation with spermogram pattern and varicocele grade in patients with a varicocele.

The relationship between infertility and varicocele is still a controversial topic. This study aimed to find the association between the venous blood gas (VBG) pattern of the spermatic veins and peripheral veins with varicocele grade and spermogram variables in infertile patients. A total of 47 patients with a varicocele were enrolled in this study. Blood samples were drawn simultaneously from the spermatic vein and a peripheral vein. The pH, partial pressure of oxygen, the partial pressure of carbon dioxide, oxygen saturation, and bicarbonate values of these samples were analysed. The mean age of participants was 30.48 ± 6.08. The mean volume of semen was 3.92 ± 1.57 mL, and the mean semen pH was 7.88 ± 0.22. The pH was higher (p < 0.01) in the spermatic vein compared with the peripheral vein. However, level of other parameters including pO2 (p = 0.662), pCO2 (p < 0.001), HCO3 concentration of serum (p < 0.01), and base excess (p = 0.172) were lower in the spermatic vein in comparison with the peripheral vein. Correlations between VBGs determinants of the varicocele patients' spermatic vein and sperm morphology and motility were insignificant. In conclusion, although the clinical significance of VBGs is evident, there are limited studies that investigated the VBGs in varicocele patients. We should consider that the deviation in blood gases may be the missing piece in the puzzle to understand the pathophysiology of varicocele. By knowing the pathophysiology more precisely, we can better decide the ideal treatment option for the patients.