The Varicocele’s Impact over the Masculine Fertility

1. The Varicocele’s Impact over the Masculine Fertility . Author: PopaGrigore Research Adviser: University Assistant Dr. Plesca Eduard

2. Varicocele • A varicocele is an abnormal tortuosity and dilatation of the testicular veins within the spermatic cord. Introduction

3. Varicocele • General population prevalence 15%-20% • The prevalence in men presenting with infertility 20% to 40% • 10% bilateral • 90% of varicoceles are left sided • Incidence

4. Varicocele • Valsalva (supine andhorizontal). • Testesvolumes (bilateral). • Scrotaltemperature (thermography). • Dopplerultrasund- reflux. • Scrotalultrasaund. • Labtests: sperm analysis, hormon. Diagnosis

5. Varicocele • Grade 0 - Subclinical varicocele; cannot be detected during physical examination; generally identified with ultrasonographic study or venography. • Grade 1 - Detected with palpation with difficulty (< 1 cm); increase in size with Valsalva maneuver • Grade 2 - Easily detected without Valsalva maneuver (1-2 cm) • Grade 3 - Detected visually at a distance (>2 cm) Classification

6. Varicocele 1) left renal vein Vs. Inferior vena cava. 2) absence of the venous valves: L > R 3) the left renal vein may be compressed between the superior mesenteric artery and the aorta. "nutcracker phenomenon" 4)Increased length of the left testicular vein: The left vein is 8-10 cm longer than the right testicular vein. • Unilateral right-sided varicoceles are uncommon and raise the possibility of thrombosis or occlusion of the vena cava (as with a right-sided renal tumor with vena caval thrombosis) or situsinversus. Causes

7. Varicocele Cause

8. Varicocele Pathophysiology Venous reflux • Dilatation of venous plexus • Hydrostatic pressure • Testicular temperature • Testicular function

9. Varicocele • Increased intracapillary pressure- Interstitial Edema. • Normal Testis Testis with varicocele Pathophysiology H2O Pc-25mm H2O Pc-11mm

10. Varicocele • Reasons for altered sperm production, testicular size, and morphologic changes are not clearly understood. Proposed mechanisms for this pathophysiology include the following: • Dilated veins with pooling of venous blood results inincreased scrotal and testicular temperature. This is theorized to alter DNA synthesis within the testicle, leading to morphologic changes in sperm and testicular tissue. • Pathophysiology

11. Varicocele • Low oxygen content in the dilated veins may result in local tissue hypoxia. This could affect both testicular architecture and sperm production. • Renal and adrenal metabolites that reflux into dilated spermatic veins affect testicular tissue damage through undefined mechanisms. Testicular hormone function may be compromised, leading to impaired spermatogenesis. • Pathophysiology

12. Varicocele • Impact of Varicocele on Sperm Quality

13. Varicocele • Methods of surgical treatment

14. Varicocele • Surgical treatment

15. Varicocele Inguinal and sub-inguinal approach is the most commonly used by surgeons. Anatomy familiar, low morbidity and high efficacy of these surgical approaches are ideal. Ligation groin incision is made ​​through the inguinal canal up to external inguinal ring. After isolation of testicular artery is preserved and umbilical cord veins are ligated and sectioned • Surgical treatment

16. Varicocele • Surgical treatment

17. Varicocele • Surgical treatment

18. Varicocele • GoalsandEvidence

19. Varicocele • Title The agedistribution, disease grading at presentation, treatmentstrategiesandsuccess rate on patientswithvaricocelle, managed in The 3rd Municipal Hospital, Chișinău and in The 3rd Municipal Pediatric Hospital, Chișinău

20. Varicocele • PatientsandMethod • Retrospective study; • Inclusioncriteria: malepatients≤19y presentingwithvaricocelle; • Exclusioncriteria: secondarytreatment, age> 19y. • Statistic relationship on theresultscollectedconcerningtheagedistribution, disease grading at presentation, treatmentstrategiesandsuccess rate on patientswithvaricocelle;

21. Varicocele n = 20p • Goals and Evidence

22. Varicocele • Goals and Evidence 75% 25%

23. Varicocele 100% of patients were treated using the Inguinal method (Ivanissech) • Goals and Evidence All the patients presented no complications and were fully treated at release from hospital.

24. Varicocele • The varicocele is most commonly first diagnosted in young males between 11 and 19 years old and in a quite advanced grade. • Varicocele does not affect erection nor the sexual intercourse, but the treatment delay can cause serious problems of infertility. • The treatment of first choice for all the patients was the Ivanissech method. • The inguinal surgical intervention (Ivanissech) presents a good result at the release from hospital. • Conclusions

25. Varicocele