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Grade III Varicocele Surgical Treatment using Spermatic Vein-Superficial Abdominal Vein Shunt
Published on: August 23, 2024
Intraoperative varicocele anatomy: a macroscopic and microscopic study
E M Beck1, P N Schlegel, M Goldstein
1Division of Urology, New York Hospital-Cornell Medical Center, New York.
The Journal of Urology
|October 1, 1992
Summary
Varicocele surgery can be improved by identifying and ligating all dilated veins, including external spermatic and gubernacular veins. Careful dissection is crucial to avoid damaging the testicular artery and lymphatics, reducing recurrence rates.
Area of Science:
- Urology
- Surgical Anatomy
- Male Infertility
Background:
- Varicoceles affect up to 41% of infertile men.
- Detailed anatomy of spermatic cord structures in infertile men is not well-described.
- Understanding these structures is key to improving surgical outcomes.
Purpose of the Study:
- To describe the intraoperative macroscopic and microscopic anatomy of the spermatic cord and gubernaculum in infertile men with varicoceles.
- To identify key anatomical variations that may contribute to varicocele recurrence.
- To propose surgical modifications for reducing varicocele recurrence.
Main Methods:
- Detailed intraoperative macroscopic and microscopic dissections of the spermatic cord and gubernaculum.
- Analysis of 115 palpable varicoceles in 83 infertile men.
- Identification and documentation of veins, arteries, and lymphatics.
Main Results:
- Enlarged veins traversing the gubernaculum were found in 48% of dissections.
- Enlarged external spermatic veins were present in 74% of cords.
- The testicular artery was often adherent to internal spermatic veins (50%) or surrounded by veins (30%).
- An average of 3.6 lymphatics per cord were identified and preserved.
Conclusions:
- Surgical approaches should ligate external spermatic and gubernacular veins to decrease recurrence.
- Failure to ligate small internal spermatic veins may lead to recurrence.
- Individual identification and ligation of large internal spermatic veins are essential, preserving the testicular artery and lymphatics.
- Optical magnification is vital for precise anatomical identification during surgery.
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