Hai Li1, Muchun Zhang1, Yang Jiang2, Zhuo Zhang1, Wanli Na3. 1. Department of Urology, China and Japan Union Hospital of Jilin University, Changchun City, Jilin Province, China. 2. Department of Colon, China and Japan Union Hospital of Jilin University, Changchun City, Jilin Province, China. 3. Department of Urology, China and Japan Union Hospital of Jilin University, Changchun City, Jilin Province, China. Electronic address: 895491670@qq.com.
Abstract
OBJECTIVE: To assess the therapeutic effectiveness of microsurgical spermatic-inferior epigastric vein anastomosis for the treatment of nutcracker syndrome (NCS)-associated varicocele in infertile men. METHODS: We prospectively analyzed 5 infertile men with NCS-associated varicocele between April 2010 and January 2012. All patients underwent microsurgical spermatic-inferior epigastric vein anastomosis. RESULTS: The mean operation time was 85.0 ± 13.2 minutes, and the mean postoperative hospital stay was 6.0 ± 0.7 days. During a 1-year follow-up, hematuria completely resolved in 66.7% of patients (2/3) and flank pain resolved in the single patient affected. The peak velocity (PV) at the aortomesenteric portion of the left renal vein (LRV) significantly decreased after surgery (167.24 ± 41.68 cm/s vs 46.98 ± 4.22 cm/s). The PV ratio between the aortomesenteric and hilar portion of the LRV also significantly decreased (12.28 ± 2.32 preoperatively vs 3.40 ± 0.67 postoperatively). The mean sperm count and motility at 6 months (24.38 × 10(6)/mL ± 1.58 × 10(6)/mL and 53.96% ± 6.28%, respectively) and 12 months (30.02 × 106/mL ± 3.52 × 106/mL and 59.40% ± 8.59%, respectively) postoperatively were significantly higher than their preoperative values (15.8 × 106/mL ± 4.53 × 106/mL and 26.76% ± 8.68%, respectively). Overall, 80% of the spouses of patients (4/5) went on to conceive naturally. The complications observed were scrotal edema in 1 patient (20%) and wound infection in 1 patient (20%). CONCLUSION: Microsurgical spermatic-inferior epigastric vein anastomosis is a safe and efficient surgical treatment for infertile men with NCS-associated varicocele.
OBJECTIVE: To assess the therapeutic effectiveness of microsurgical spermatic-inferior epigastric vein anastomosis for the treatment of nutcracker syndrome (NCS)-associated varicocele in infertile men. METHODS: We prospectively analyzed 5 infertile men with NCS-associated varicocele between April 2010 and January 2012. All patients underwent microsurgical spermatic-inferior epigastric vein anastomosis. RESULTS: The mean operation time was 85.0 ± 13.2 minutes, and the mean postoperative hospital stay was 6.0 ± 0.7 days. During a 1-year follow-up, hematuria completely resolved in 66.7% of patients (2/3) and flank pain resolved in the single patient affected. The peak velocity (PV) at the aortomesenteric portion of the left renal vein (LRV) significantly decreased after surgery (167.24 ± 41.68 cm/s vs 46.98 ± 4.22 cm/s). The PV ratio between the aortomesenteric and hilar portion of the LRV also significantly decreased (12.28 ± 2.32 preoperatively vs 3.40 ± 0.67 postoperatively). The mean sperm count and motility at 6 months (24.38 × 10(6)/mL ± 1.58 × 10(6)/mL and 53.96% ± 6.28%, respectively) and 12 months (30.02 × 106/mL ± 3.52 × 106/mL and 59.40% ± 8.59%, respectively) postoperatively were significantly higher than their preoperative values (15.8 × 106/mL ± 4.53 × 106/mL and 26.76% ± 8.68%, respectively). Overall, 80% of the spouses of patients (4/5) went on to conceive naturally. The complications observed were scrotal edema in 1 patient (20%) and wound infection in 1 patient (20%). CONCLUSION: Microsurgical spermatic-inferior epigastric vein anastomosis is a safe and efficient surgical treatment for infertile men with NCS-associated varicocele.
Authors: Federica A Vianello; Marta B M Mazzoni; Gabriëlla G A M Peeters; Emilio F Fossali; Pietro Camozzi; Mario G Bianchetti; Gregorio P Milani Journal: Pediatr Nephrol Date: 2015-01-28 Impact factor: 3.714