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[Causes of persisting postoperative varicoceles]

L V Wagenknecht, R Hubmann, B Schütte

    Andrologia
    |January 1, 1980
    PubMed
    Summary

    Persistent varicoceles after surgery are often caused by overlooked venous branches or collateral circulation. Preoperative phlebography is recommended to identify these complex venous anomalies before surgical intervention.

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    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.

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