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Paper 4
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
The patient has a right-sided varicocele. Varicoceles are more common on the left due to the drainage of the left testicular vein into the left renal vein. The right testicular vein drains directly into the lower pressure inferior vena cava. If a varicocele is just on the right side, then ultrasound of the abdomen, to focus on the retroperitoneal structures, should be performed to ensure there is not an underlying pathology, such as a mass, impeding venous return. If ultrasound cannot be confidently used to assess this, for example in patients with a high body mass index, then other modalities could be considered. Treatment for uncomplicated varicoceles include surgical ligation or embolisation.
The Infertile Male
Published in Arianna D'Angelo, Nazar N. Amso, Ultrasound in Assisted Reproduction and Early Pregnancy, 2020
Thoraya Ammar, C. Jason Wilkins, Dean C.Y. Huang, Paul S. Sidhu
Ultrasound holds its place as the primary imaging modality in investigating the causes of male infertility. Essentially it remains noninvasive, safe, widely available, and effective in detecting and identifying causes relevant to male infertility. Magnetic resonance imaging (MRI) is useful in problem-solving. Imaging-guided interventions, such as fluoroscopic-guided testicular vein embolization in the management of testicular varicoceles, offer additional therapeutic options.
Reproductive system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Testicular vein embolisation is performed on men suffering from varicoceles. As in ovarian vein reflux, when the venous valves fail to function, the venous blood flows back down the testicular veins causing the tiny veins around the testicle to stretch and enlarge, causing a varicose vein or a varicocele.
Outcome of varicocelectomy on different degrees of total motile sperm count: A systematic review and meta-analysis
Published in Systems Biology in Reproductive Medicine, 2019
Qun Wang, Yang Yu, Yanhong Liu, Libo Wang
It is crucial to identify the factors predicting the response to varicocelectomy. Some investigators have claimed that testicular vein with higher grades of reflux and diameter >2.5 mm resulted in greater improvement in sperm parameters (Mehraban et al. 2012), while others have reported that postoperative varicocele size failed to demonstrate any statistically significant improvement in SP rates (Marks et al. 1986). Similarly, some studies have confirmed the absence of testicular atrophy as a predictor of higher postoperative SP rates (Marks et al. 1986), while others have concluded that a small-sized left testis decreases the likelihood of improvement in pregnancy (Fujisawa et al. 2002). Additionally, several studies have demonstrated that men with raised FSH levels are more likely to show non-response to varicocelectomy (Schrepferman et al. 2000; Fujisawa et al. 2002). Sperm concentration independently predicts the efficacy of varicocelectomy, and it is reported that men with sperm concentration >2 million/mL had a 56.3% improvement in sperm parameters and a 25% improvement in SP rates (Enatsu et al. 2014). While others have concluded that if sperm concentration is <5 million/mL, then couples should initially consider ART rather than varicocelectomy, because of its low SP rates (Kamal et al. 2001).
The prevalence and severity of varicocele in adult population over the age of forty years old: a cross-sectional study
Published in The Aging Male, 2019
Huseyin Besiroglu, Alper Otunctemur, Murat Dursun, Emin Ozbek
Varicocele is an abnormal dilatation of internal spermatic veins within the pampiniform plexus. Varicoceles are a frequent scrotal finding in normal males. Although the pathogenesis and natural history remain controversial, varicocele is thought to contribute to the risk of infertility in men. Furthermore, two population-based studies indicate that 85% of men with varicocele have fathered children suggesting that its effect on paternity is less clear [1,2]. The underlying pathologic process is not well known, but varicoceles have been associated with turbulent venous flow related to the right angle insertion of the left testicular vein into the left renal vein, which could be an explanation why left-sided varicocele is observed more frequently. In addition, the nutcracker phenomenon, defined as the compression of the left renal vein between superior mesenteric artery and aorta, may contribute to the pathogenesis of varicocele [3,4].
Role of varicocele treatment in assisted reproductive technologies
Published in Arab Journal of Urology, 2018
Mehmet G. Sönmez, Ahmet H. Haliloğlu
Testicular varicocele is the abnormal expansion of the pampiniform plexus, which provides testicle venous drainage. It is the most common treatable cause of male infertility worldwide. It is detected in 40% of men with infertility and nearly 15% of adult men generally [1]. Varicocele may cause testicular atrophy, discomfort, infertility, and hypogonadism. Varicocele aetiology is not entirely clear, with venous reflux thought to be the main cause of varicocele-related testicular dysfunction [1,2]. There are three hypotheses for venous blood drainage impairment: (i) lack of or functional disorder in the venous valves, (ii) differences in the attachment of the testicular veins to the left renal vein and vena cava, and (iii) renal vein compression between the upper mesenteric artery and aorta (the ‘nutcracker’ effect) [2[3]–4]. Intratesticular temperature increase, testicle hypoxia, oxidant accumulation in the semen, renal and adrenal metabolite reflux, and anti-sperm antibodies may result in varicocele-related testicular dysfunction [5], and these are all a reflection of venous reflux effects. Varicocele may cause changes at the cellular level, which may induce testicular cell apoptosis and increase reactive oxygen species (ROS), decrease testicular DNA polymerase activity, change Sertoli cellular function, and decrease testosterone production by Leydig cells [6]. These, secondary to varicocele, can result in infertility.