[Right varicocele: contribution of spermatic phlebography. Results on 250 cases]

Full details of the technique employed for right testicular vein phlebography during investigation of male sterility are exposed, and the presence of a varicocele defined among 250 cases explored. Diagnosis of a varicocele is confirmed when there is reflux filling of the pampiniform plexus veins at the scrotal level, the lesion being considered absent when a continent valve prevents any descent of the contrast medium column. Successful catheterization of the right testicular vein was accomplished in 193 cases (66%) of the last 250 bilateral testicular vein phlebographs performed, enabling data concerning the radiological anatomy of this vein to be obtained. In 95%t of cases it emptied into the inferior vena cava and in the other 5% into the renal vein, between L1 and L3, while in 7% the vein emptied into both. Anastomoses are frequent: with the exorenal circle (15 to 18% of cases); the intercostal veins; the lumbar and perivertebral system; the inferior vena cava; the peri-ureteral veins; the testicular vein itself, and finally the portal system through a colic trunk emptying into the inferior mesenteric vein (29% of cases). The frequency and characteristics of right-sided varicocele in patients with male secretory infertility is discussed in relation to findings in these 250 cases. Bilateral phlebography in 187 patients showed normal appearances in 25 cases, bilateral varicoceles in 96, and unilateral varicoceles (including 27 on the right) in 66 cases. Unilateral phlebography in 55 patients revealed the presence of an isolated right-sided varicocele in 4 patients. The question is raised as to the need for phlebography in patients with clinically evident varicoceles, and inversely, the significance of a varicocele demonstrated only on radiology. Physiopathological studies could possibly determine the effect of a varicocele on testicular function. A suggested means of treatment is by embolization of the valvular incontinent venous system.