From October 1985 to October 1988, fourty-nine impalpable testis in 39 patients were treated. The ages of the patients ranged from lyear 10 months to 11 years. There were fixed testis into scrotum (in 24 cases), superficial layer of aponeurosis of musculus obliquus externus abdominis (in 4 cases), autotransplantation (in 7 cases), and testectomy (in 11 cases). No testis in 3 cases were conformed in exploration. The author suggestes it necessary to do exploration early in impalpable testis of children to obtain good physiologic function of testis.
Varicocele is a common disease.The treatment of varicocele. is verea-tile. Eighteen cases were treated byanastomosis of the testicular vein withthe profundus circumflexa iliac vein,The intra-operative measurement ofthe venous pressure has shown to bea singnificant improvement. Follow-up lasted from 9 months to 2 years.Good resulss were achieved in 17 caseswith 1 failure from dead sperm.
Objective To evaluate the effectiveness and safety of microsurgical varicocelectomy (MV) compared with Palomo surgery for male varicocele. Methods MEDLINE (1985-October 2008), EMbase (1990-October 2008), China Biology Medicine Literature Disc Database (1979-October 2008), CMCC (1979-October 2008) and CNKI (1990-October 2008) were searched electronically by computer. Addtionally, four relevant journals were searched manually to get randomized controlled clinical trials about the comparison of MV and Palomo in the treatment of varicocele. Two reviewers screened the literature, evaluated the document quality, extracted the data independently, and checked the result together. RevMan software version 4.3.1 developed by the Cochrane Collaborative was used for meta-analysis. Results Seven RCTs reporting data on effectiveness and safety of MV versus palomo surgery were included. Meta-analyses showed that MV was superior to palomo surgery in improving sperm motility [RR= 1.21, 95%CI (1.09, 1.34), P=0.000 5], concentration [RR= 1.35, 95%CI (1.20, 1.51), Plt;0.000 01] and also postoperation natural pregnancy rate [RR= 1.34，95%CI (1.08, 1.66), P=0.008]. While the MV group had a longer operation time in unilateral [WMD= 23.01 min, 95%CI (16.86, 29.16), Plt;0.000 01] or bilateral varicocele [WMD= 34.05 min, 95%CI (4.9, 63.21), P=0.02] than Palomo surgery. The recovery time difference in the two groups was not significant. The incidence of varicocele recurrence was significantly lower in the MV group than in the Palomo group [RR= 0.17, 95%CI (0.10, 0.31), Plt;0.000 01], and the incidence of postoperative hydrocele was also significantly lower in the MV group than in the Palomo group [RR= 0.10, 95%CI (0.05, 0.23), Plt;0.000 01]. The incidences of wound infection, scrotal hematoma and scrotal pain were similar in both groups. Conclusion The evidence shows that MV is superior to Palomo surgery because of the higher sperm improvement rate, higher natural pregnancy rate and lower incidence of recurrence and hydrocele. But the operation time is longer. The long-term effect and overall effectiveness of MV need more high-quality RCTs to confirm.
目的:提高对精索副神经节瘤的诊断和治疗认识。方法:报告我院2009年2月收治1例精索副神经节瘤患者,并复习文献。患者,男,66岁,因发现右侧阴囊上部包块20年入院。查体发现双侧精索静脉曲张,右侧阴囊上部占位,B超提示双侧精索静脉曲张,右侧阴囊上部34 mm×28 mm不均质包块,血供丰富。结果:行双侧精索静脉高位结扎及右侧精索包块切除术。术中见包块程球形、质中等、边界清楚。术后病检:副神经节瘤。1周后行扩切,未发现有肿瘤浸润。术后随访2月至今无复发及转移。
ObjectiveTo systematically evaluate the efficiency and safety of interventional embolization versus laparoscopic surgery in the treatment of varicocele. MethodsWe searched the Chinese Journal Full-text Database, Wanfang Medical Journal Database, and VIP Chinese Science and Technology Journal Full-text Database with such keywords as interventional therapy, embolization, laparoscope, and varicocele. For PubMed and Cochrane Library, MESH terms or keywords were interventional embolization, interventional therapy, embolization, laparoscope, laparoscopic surgery, and varicocele. All database were searched up to March 2015. Then we selected trials comparing interventional embolization versus laparoscopic surgery in the treatment of varicocele according to the including criteria. We assessed the quality of the included studies with the Newcastle-Ottawa Scale and conducted meta-analysis with revman 5.2 for the primary outcomes sperm improvement rate, recurrence rate, complication rate, pregnant rate, etc. ResultsWe included 7 trials comparing interventional embolization with laparoscopic surgery, including 1 prospective study and 6 retrospective studies, with a total of 349 patients receiving interventional therapy and 400 patients receiving laparoscopic surgery. Meta analysis of the included studies showed that there were no significant differences for sperm improvement rate[OR=1.17, 95%CI (0.70, 1.96), P=0.54], pregnant rate[OR=0.58, 95%CI (0.29, 1.13), P=0.11], recurrence rate[OR=0.84, 95CI% (0.40, 1.78), P=0.66] or complication rate[OR=0.68, 95%CI (0.34, 1.32), P=0.25] between the two groups. ConclusionPresent evidence shows that there is no significant difference between interventional embolization and laparoscopic surgery for varicocele.
ObjectiveTo systematically review the effectiveness and safety of laparoendoscopic single-site surgery (LESS) for varicocele. MethodsSuch databases as The Cochrane Library, MEDLINE, EMbase, CBM, CNKI, and WanFang Data were electronically searched for studies about LESS and traditional laparoscopy for varicocele till March 1st, 2013. According to the inclusion and exclusion criteria, literature was screened, data were extracted, and the methodological quality of included studies was also assessed. Then, meta-analysis was performed using RevMan 5.1 software. ResultsSeven RCTs involving 452 cases were included. The results of meta-analysis showed that, there was no significant difference between LESS and traditional laparoscopy for varicocele on post-operational complications (RR=0.57, 95%CI 0.26 to 1.27, P=0.17), duration of hospital stay (MD=-0.30, 95%CI-0.87 to 0.26, P=0.30), improvement of semen parameters, and blood loss. However, LESS had longer duration of operation (MD=11.26, 95%CI 3.62 to 18.90, P=0.004). ConclusionThe effectiveness and safety of LESS and traditional laparoscopy for varicocele are similar, and LESS could achieve more beautiful and natural effects which has longer surgery time on account of non-proficiency in surgery and equipment. Due to the limited quantity and quality of the included studies, the above conclusion requires to be proved by more high quality randomized controlled trials.
Varicocele (VC) is one of the common diseases of the male genitourinary system, and its incidence is higher in young adults. Among them, 80%-98% of VC are more likely to occur in the left spermatic vein. Previous research has found that VC could affect the temperature of the local microenvironment of the testis, oxidative stress process in the spermatogenic environment, mitochondrial function of sperm, endocrine system, and apoptosis of testes and epididymal cells. Therefore, VC will have an important impact on spermatogenic process of the testicles to cause male infertility. However, the specific molecular mechanism of VC affecting male spermatogenesis has not been fully studied. Therefore, this article will review the effect and mechanism of VC on testicular spermatogenesis.
Objective To explore the feasibility of microscopic spermatic vein ligation for unilateral varicocele under daytime surgical mode. Methods The clinical data of patients with unilateral varicocele who underwent daytime surgical treatment at the General Hospital of Northen Theater Command between January and December 2022 were retrospectively analyzed. The relevant indicators of patients were collected, including age, surgical time, intraoperative blood loss, total hospitalization expenses, and postoperative condition. Results A total of 159 patients were included, aged 18-41 years, with an average age of (27.79±4.80) years, an average surgical time of (49.23±5.57) minutes, and an average intraoperative blood loss of (8.94±3.58) mL. One patient had fever, nausea and acid regurgitation on the 2nd day after discharge, and one patient had urinary retention on the day after operation. Five patients had a pain score of ≥3 in the surgical area on the 1st day after surgery. All patients had no postoperative incisions with bleeding or hematoma. Follow up showed that all patients returned to normal life on the 3rd day after surgery and returned to work on the 10th day after surgery. At 3-6 months after surgery, the sperm quality of 94 patients improved. One patient experienced disease recurrence 6 months after surgery. Conclusion Microscopic spermatic vein ligation for unilateral varicocele under daytime surgical mode is safe and feasible, and is worthy of promotion.