[Causes of persisting postoperative varicoceles]

Area of Science:

• Urology
• Vascular Surgery
• Radiology

Background:

• Varicocele is a common cause of male infertility.
• Surgical ligation of the internal spermatic vein (vena spermatica interna) is a standard treatment for varicocele.
• Persistent varicoceles after surgery can occur due to various venous anomalies.

Purpose of the Study:

• To investigate the causes of persistent varicoceles after surgical ligation of the internal spermatic vein.
• To evaluate the role of phlebography in identifying the reasons for treatment failure.

Main Methods:

• Retrospective analysis of 18 patients with persistent varicoceles after internal spermatic vein ligation.
• Phlebography performed on all 18 patients to visualize venous anatomy.
• Review of surgical techniques and patient outcomes.

Main Results:

• Persistent varicoceles were observed in 1% of 519 patients undergoing high ligation of the internal spermatic vein.
• Phlebography revealed overlooked venous branches in 2 cases, collateral veins to the paravertebral plexus in 3 cases, and combined anomalies in 13 cases.
• Identified collateral anastomoses to the presacral- and paravertebral plexus, V. iliaca, V. femoralis, and contralateral venous systems.

Conclusions:

• Persistent varicoceles are frequently caused by overlooked venous branches and collateral circulation.
• Preoperative phlebography is crucial for accurate diagnosis and planning of surgical interventions.
• Intraoperative diagnosis may be technically challenging and less comprehensive than preoperative imaging.