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Chirurgie-generala Varicele mesh iod

The NCBI web site requires JavaScript to function. A varicocele is described as pathologically enlarged, tortuous veins of the pampiniform plexus, leading to an increased testicular temperature and adrenal metabolite reflux into the testes. Varicocele can impair spermatogenesis and is considered to be the most common cause of male infertility. Patients may palpate a thickening in the scrotum or complain of dull scrotal or inguinal pain, which increases when standing or during erection.

In the case of a sudden onset of varicocele in elderly men, it is necessary to exclude renal tumor and extend diagnostic ultrasound with the assessment of the abdominal cavity. The diagnosis of varicocele is based on medical history and physical examination, which involves palpation and Varicele mesh iod of the scrotum at rest and during the Valsalva maneuver.

Ultrasound is the imaging method of choice. The width and the number of vessels in the Varicele mesh iod plexus as well as the evaluation and measurement of regurgitation during the Valsalva maneuver are typical parameters analyzed during ultrasound assessment.

However, diagnostic ultrasound is still a controversial method due to numerous and often divergent classification systems for varicocele assessment as well as its poor correlation with clinical manifestations. As a result of introduction of clear ultrasound criteria as well as the development of elastography and nuclear magnetic resonance, diagnostic imaging can play an important role in assessing the risk of damage to the testicular parenchyma, qualifying patients for surgical treatment and predicting the effects of therapy.

A varicocele, defined as a pathological enlargement of the pampiniform plexus with veins often running in a winding course, Varicele mesh iod considered the most common cause of male infertility 1. Epidemiological data also indicate an increasing incidence of varicocele și tromboflebită, sarcinii tratamentul age: The etiology of varicocele is multifactorial. The left testicular vein runs vertically and enters Varicele mesh iod left renal Varicele mesh iod at a right angle, which predisposes to turbulent blood flow and reverse pressure, while the right testicular vein opens directly into the inferior vena cava at a sharp angle 67.

The lack or incompetence of testicular vein valves are another factor predisposing to reverse pressure. Testicular venous developmental variants are significantly more commonly observed in boys with varicocele compared to adult men 9 Compression of the left renal or testicular vein, either as a result of the so-called nutcracker mechanism or due to renal or retroperi-toneal tumors, is a relatively rare cause of varicocele 6 A sudden onset of varicocele in a man over Varicele mesh iod age of 30 years requires the exclusion of renal tumors, particularly in elderly patients.

In such cases it is necessary to extend diagnostic ultrasonography with abdominal examination. Researchers suggested several pathophysiological mechanisms underlying the adverse effects of varicocele.

Varicele mesh iod seems that an increase in the scrotal temperature is the most likely cause of endocrine and spermatogenic testicular dysfunction 12 Spermatogenesis disorders can also result from renal and adrenal metabolite reflux into the left testicular Varicele mesh iod 14 It has also been shown that Leydig cell dysfunction with a secondary reduction of intratesticular testosterone levels as well as an impairment of both Sertoli cell secretory function and sperm maturation process affect both testes, regardless of whether the varicocele is uni- or bilateral 16 Varicocele reduces semen quality.

In see more cases, treatment using varicocelectomy or obliteration of varicose veins is attempted. Indications for this type of treatment Varicele mesh iod infertility and pain during physical activity or sexual intercourse, which is typical of varicocele Varicocele without concomitant pain or semen pathology is not an indication for surgical treatment. The diagnosis of varicocele is based on medical history and physical examination.

Most patients with varicocele are asymptomatic. Other patients may palpate a scrotal thickening above the testis or complain of dull pain in the click to see more or groin, increasing during a long-lasting standing position or erection.

Physical examination involves palpation and observation of the scrotum at rest and during the Valsalva maneuver. Classification proposed by Dubin and Amelar is still the most widely used system for the assessment of the severity of varicocele It is recommended for qualifying patients for surgical treatment Tab.

However, they are not used in common clinical practice. Only the WHO classification, which expanded the division proposed by Dubin and Amelar with the definition of subclinical varicocele, which are diagnosed only based on imaging techniques, has gained general acceptance Tab.

Physical examination is often ambiguous due to click to see more subjective nature and dependence on the experience of the examiner. It is of limited value in Varicele mesh iod obese patients, patients with high-located testes, those with a history of surgery in the scrotal or groin region, Varicele medicina tradițională with a coexistent Varicele mesh iod as well as in patients with postoperative recurrence of varicocele.

Ultrasound assessment may be very helpful or even necessary in these cases. However, the use of ultrasonography is not generally recommended. Varicele mesh iod is recommended only by the European Association of Urology in patients with visible or palpable dilated veins in the pampiniform plexus The infertility diagnostics recommended by the American Association of Urology does not involve standard ultrasound assessment in patients with varicocele According to the American Society for Reproductive Medicine, ultrasonography should not be used as a basic examination in all patients with varicocele, but its place in the diagnostic algorithm should be defined as complementary These differences result from the controversy regarding the role of subclinical varicocele in the development of infertility as well as the lack of clearly confirmed beneficial effects of surgical treatment in this patient population 24source Currently, ultrasound is the most commonly performed imaging technique in patients with varicocele.

A linear transducer with a frequency of 7—14 MHz and with real-time Doppler function is the minimum hardware requirement to evaluate varicocele, as in accordance with the American Institute Varicele mesh iod Ultrasound in Medicine It is important to avoid excessive compression of the scrotum by the ultrasound transducer as this reduces the vessel diameter and increases flow rate in Doppler analysis.

The apparatus should be able to document the obtained images in analogue or digital form. The examination should be performed in a warm room, using preheated ultrasound gel and ensuring intimacy for the patient.

Ultrasound examination of varicocele is performed in a patient in a supine position. It is preceded by a manual examination of the scrotum, necessary for a proper interpretation of the ultrasound image. The measurement of the diameter of the veins in the pampiniform plexus Fig. This is followed by the Valsalva maneuver, during which the diameters of the veins in the pampiniform plexus are measured and regurgitation is evaluated.

This allows to obtain diagnostic images with no motion artifacts. Additionally, the examination should be performed in a standing position and include vascular diameter measurements with the assessment of changes in flow direction between rest and the Valsalva maneuver.

The inguinal channel, the upper part of the Varicele mesh iod as well as the supra- and peritesticular regions should be checked for the presence of varicocele. The US assessment of regurgitation may be performed using color or spectral Doppler. The reverse flow during the Valsalva maneuver is associated with Doppler color changes Fig. The assessment of reflux based on the spectral flow Varicele mesh iod focuses on identifying a change in the flow direction as well as on the measurement of flow duration and maximum velocity Fig.

Ultrasonography also allows for testicular volume measurement, which is of significant importance for the pre- and postoperative assessment as well as conservative treatment 28 The volume is expressed in milliliters, and the measurement is performed using an ellipsoid volume formula, i. Despite the popularity of ultrasound imaging, there is no universal and recognized system to classify varicocele Varicele mesh iod. There are several methods for their assessment, which are mainly based on venous width measurement, evaluation of blood flow direction at rest and during the Valsalva maneuver as well as reflux duration and the rate of regurgitation.

Although the first systems for the assessment of the size of varicocele were already based on the measurement of the diameter of the veins in the pampiniform plexus, there still are some discrepancies between the methods for click at this page evaluation. The main reason for this is the lack of clear boundary values for the diameter of the veins in the pampiniform plexus Tab.

Apart from vascular dilation, the presence of regurgitation is another important parameter for the assessment of varicocele.

Varicocele is graded based on reflux assessment by a number of classification systems. One of the first classification systems was proposed by Sarteschi Grade 1—3 reflux does not cause scrotal deformation or Varicele mesh iod hypotrophy, which distinguishes it from grade 4 reflux, which is accompanied by scrotal deformation and, often, testicular Varicele mesh iod arrest as well as grade 5 reflux, which is always accompanied by testicular hypotrophy Tab.

This extensive classification is not widely used for the assessment of varicocele, which is also the case of the classification system proposed by Chiou.

This system takes into account the maximum venous diameter scores 0 to 3the presence of venous plexuses scores 0 to 3 and a change in flow direction during the Valsalva maneuver scores 0 to 3. A score of at least 4 is required for the diagnosis of Varicele mesh iod There are several other modifications of the above classification systems, which are also based on reflux assessment, e.

The criticism of the above described classification systems is primarily related to their poor correlation with the clinical status of patients qualified for varicocele surgical treatment. Furthermore, they are of low predictive value for impaired spermatogenesis, which is the primary indication for surgical treatment Recently proposed classification systems based on the assessment of regurgitation velocity or duration in varicocele during the Valsalva maneuver put great emphasis on the correlation between the identified manifestations and the clinical status as well as the course of disease 28 It evaluates the maximum regurgitation velocity during the Valsalva maneuver and the difference in venous diameters at rest and during the Valsalva maneuver.

According to a number of authors, surgical treatment in this group of patients should be initiated as early as possible to avoid testicular hypotrophy. Conservative treatment and an active follow-up are the method of choice in this patient population. The role of ultrasonography in the qualification for surgical treatment is significantly greater in adolescents than in adults as testicular volume differences, which are difficult to evaluate during physical examination, are an important parameter in this group of patients.

After varicocelectomy, improved semen parameters were observed statistically more commonly in patients with preoperative regurgitation lasting more than 4. The authors suggest that a fast and simple measurement of regurgitation duration during the Valsalva maneuver may in the future Varicele mesh iod an important ultrasonographic criterion in determining the indications for surgical treatment.

The authors investigated the duration of regurgitation in the veins of the pampiniform plexus during the Valsalva maneuver in patients in the supine position. The obtained measurements allowed to determine Varicele mesh iod intervals for the duration of regurgitation, which positively correlated with the clinical severity of varicocele, as in accordance with Dubin and Amelar Tab.

It seems that elastography may prove useful for assessing the effects of varicocele on the testes in the future. The study included 30 patients with left-sided varicocele and 30 varicocele-free men with normal laboratory findings. Comparison of both these groups demonstrated lower Varicele mesh iod stiffness values in patients with varicocele despite the absence of perceptible changes in testicular cohesion on palpation. Furthermore, the authors found an inverse correlation between elastography findings and the clinical severity of varicocele Varicele mesh iod well as the level of follicle-stimulating hormone.

The wide availability of ultrasonography has significantly limited the importance of other imaging techniques Varicele mesh iod varicocele, thermography and Varicele mesh iod medicine in particular.

Thermography allows for a detection of varicocele by identifying regional hyperthermia at the level of the pampiniform venous plexus or the testis 45 The examination is limited by its low specificity as both, scrotal inflammation and neoplasms can cause local temperature elevation 46 Scintigraphy allows for a detection of varicocele as well as for an assessment of hemodynamics of arterial and venous scrotal vascularization 48 — However, multiple Varicele mesh iod prevent the routine use of scintigraphy in varicocele diagnosis.

These include, for example, the need for intravenous radioisotope administration, and thus its more invasive nature compared to ultrasonography, heterogeneous methodology of the published studies, not entirely clear link between abnormalities reveled by scintigraphy and treatment outcomes as well as significantly lower availability. Venography, introduced by Ahlberg inrepresents a historical gold standard in the diagnosis of varicocele Currently, it is no longer applied for purely diagnostic purposes, but used for intraoperative assessment ascending Varicele mesh iod or as an introduction to intravascular treatment ascending or descending venography to evaluate the anatomy of collateral circulation and developmental variations 9 So far, there has been only one publication on the Varicele mesh iod of computed tomography in the dynamic diagnosis of the veins in the pampiniform plexus The authors evaluated the Varicele mesh iod sectional area of spermatic cords using two cross-sections, one at rest and one during the Valsalva maneuver.

Both, the cross-sectional area at rest and its percentage increase during the Valsalva maneuver was statistically higher on the side of varicocele compared to the healthy site 80— mm 2 vs. However, this subject Varicele mesh iod not continued in later publications, probably due to exposure to ionizing radiation during the examination.

CT is a recognized method for the assessment of retroperitoneal anatomy and pathology. Research using CT angiography Varicele mesh iod the role of variations in the retroperitoneal venous system, such as retroaortic left renal vein, in the etiopathogenesis of varicocele 53 Although a routine use of CT for the assessment of the retroperitoneal space in patients with varicocele is not indicated, it is justified in the case of clinical suspicion that the varicocele is a manifestation of retroperitoneal space tumor, e.

Magnetic resonance angiography represents Varicele mesh iod attractive alternative for CT scans in the assessment of the retroperitoneal space and allows for varicocele visualization. The absence of ionizing radiation and the possibility to perform the test in patients with contraindications to iodinated contrast agents are advantages of this method They demonstrated lower apparent diffusion coefficient ADC in the testes of patients with varicocele compared to healthy volunteers The lesions were bilateral, and the ADC values were inversely proportional to the degree of venous dilation.

The authors suggest that ADC reduction may reflect testicular Varicele mesh iod. However this subject needs further investigation as no correlation with histopathological findings was evaluated and no post-treatment Ulcere la pisici changes were assessed. Ultrasound is currently the most widely used imaging technique for the assessment of varicocele.

Its role in the diagnostic algorithm is still controversial, which is reflected by the differences in clinical recommendations published by recognized urologic societies. This is due to an insufficient correlation between ultrasonographic classification systems and clinical assessment of varicocele severity as well as limited prognostic value for treatment outcomes. Therefore, the future attempts of researchers and ultra-sonography societies should Varicele mesh iod to overcome these problems.

Attempts to determine the manifestations of testicular damage that precede morphological changes, which could increase the importance of imaging techniques in treatment planning, are particularly promising. National Center for Biotechnology InformationU. National Library of Medicine Rockville PikeBethesda MDUSA. NCBI Skip to Varicele mesh iod content Skip to navigation Resources How To Varicele mesh iod NCBI Accesskeys My NCBI Sign in to NCBI Sign Out. PMC US Varicele mesh iod Library of Medicine National Institutes of Health.

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Journal List J Ultrason v. Published online Dec Received Nov 9; Revised Mar 10; Accepted Mar Copyright Polish Ultrasound Society. Published by Medical Communications Sp.

This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3. Abstract A varicocele is described as pathologically enlarged, tortuous veins of the pampiniform plexus, leading to an increased testicular temperature and adrenal metabolite reflux into the testes.

Introduction A varicocele, defined as a pathological enlargement of the pampiniform plexus with veins often running in a winding course, is considered the most common cause of male infertility 1. Clinical assessment The diagnosis of varicocele picioare varicoase etapă fotografie based on medical history and physical examination. Ultrasonographic assessment Currently, Varicele mesh iod is the most commonly performed imaging technique in patients with varicocele.

Regurgitation during the Valsalva maneuver in color Doppler. Boundary values for the veins in the pampiniform plexus, above which the diagnosis of varicocele is recommended by different authors. Classification according to Sarteschi Classification of varicocele based on the measurement of the duration of regurgitation in accordance with Patil. Other imaging techniques The wide availability of ultrasonography has significantly limited the importance of other imaging techniques assessing varicocele, thermography and nuclear medicine in particular.

A large right renal cell carcinoma RCC with lymph Varicele mesh iod metastases. A tumor plug entering the inferior vena cava and filling nearly its Summary Ultrasound is currently the most widely used imaging technique for the assessment of varicocele. Fretz PC, Sandlow JI. Urol Clin North Am. Alsaikhan B, Alrabeeah K, Delouya G, Zini A. Varicocele in children and adolescents.

An investigation of the incidence among Danish school children. Scand J Urol Nephrol. Akbay E, Cayan S, Doruk E, Duce MN, Bozlu M. The prevalence of varicocele and varicocele-related testicular atrophy link Turkish children and adolescents. Levinger U, Gornish M, Gat Y, Bachar GN. Is varicocele prevalence increasing read more age?

Sofikitis N, Miyagawa I. Experimental models for the study of varicocele: Jpn J Fertil Steril. Braedel HU, Steffens J, Ziegler M, Polsky MS, Platt ML.

A possible ontogenic etiology for idiopathic left varicocele. Sofikitis N, Dritsas K, Miyagawa I, Koutselinis A. Anatomical characteristics of the left testicular venous system in man. Hart RR, Rushton HG, Belman Varicele mesh iod. Intraoperative spermatic venography during varicocele surgery in adolescents.

Nagappan P, Keene D, Ferrara F, Shabani A, Cervellione RM. Antegrade venography identifies parallel venous duplications in the majority of adolescents with varicocele. Gulleroglu K, Gulleroglu B, Baskin E. Zorgniotti AW, Macleod J. Studies in temperature, human Varicele mesh iod quality, and varicocele. Varicele mesh iod JI, Weaver DJ, Weinstein SH, Grimes EM. Scrotal temperature and semen quality in men with and without varicocele.

Comhaire F, Varicele mesh iod A. Ito H, Fuse H, Minagawa H, Kawamura K, Murakami M, Shimazaki J. Internal spermatic vein prostaglandins in varicocele patients. Rajfer J, Turner TT, Rivera F, Howards SS, Sikka SC. Inhibition of testicular testosterone biosynthesis following experimental varicocele in rats. Effects of surgical repair of experimental left varicocele on testicular temperature, spermatogenesis, sperm maturation, endocrine function, and fertility in rabbits.

Rowe PJ, Comhaire FH, Hargreave TB, Mahmoud AM, World Varicele mesh iod Organization. WHO Manual for the Standardized Investigation, Diagnosis, and Management of the Infertile Male. Cambridge — New York: Agarwal A, Deepinder F, Cocuzza M, Agarwal R, Short RA, Varicele mesh iod E, et al. Efficacy of varicocelectomy in improving semen parameters: Dubin L, Amelar RD. Varicocele size and results of varicocelectomy in selected subfertile men with varicocele.

Jungwirth A, Giwercman A, Tournaye H, Diemer T, Kopa Z, Dohle G, et al. European Association Varicele mesh iod Urology guidelines on male infertility: American Urological Association Education and Research. The optimal evaluation of the infertile male: AUA best practice statement. Practice Committee of the American Society for Reproductive Medicine.

Report on varicocele and infertility. Grasso M, Lania C, Castelli M, Galli L, Franzoso F, Rigatti P. Low-grade left varicocele in patients over 30 years old: Yamamoto M, Hibi H, Hirata Y, Miyake K, Ishigaki T. Effect of varicocelectomy on sperm parameters and pregnancy rate in patients with subclinical varicocele: Studniarek M, Skrobisz-Balandowska K, Modzelewska E.

American Institute of Ultrasound in Medicine. American College of Radiology; Society of Radiologists in Ultrasound: AIUM practice guideline for the performance Varicele mesh iod scrotal ultrasound examinations. Kozakowski KA, Gjertson CK, Decastro GJ, Poon S, Gasalberti A, Glassberg KI. Goren MR, Erbay G, Ozer C, Kayra MV, Hasirci E.

Can we predict Varicele mesh iod outcome of varicocelectomy based on the duration of venous reflux? Rifkin MD, Foy PM, Kurtz AB, Pasto ME, Goldberg BB.

The role of diagnostic ultrasonography in varicocele evaluation. Diagnosis of subclinical varicocele in infertility. AJR Am J Roentgenol. Hoekstra T, Witt MA. The correlation of internal spermatic vein palpability with ultrasonographic diameter and reversal of venous flow. McClure RD, Khoo D, Jarvi K, Hricak H. Eskew LA, Watson NE, Wolfman N, Bechtold R, Scharling E, Jarow JP. Ultrasonographic diagnosis of varicoceles. Metin A, Bulut O, Temizkan M. Relationship between the left spermatic vein diameter measured by ultrasound and palpated varicocele and Doppler ultrasound findings.

Orda R, This web page J, Manor H, Witz E, Sofer Y. Diagnosis of varicocele and postoperative evaluation using inguinal ultrasonography. Lo studio del varicocele con eco-color-Doppler. Chiou RK, Anderson JC, Wobig RK, Rosinsky DE, Matamoros AuswГhlen boala tromboflebită RГckkehr, Jr, et al.

Color Doppler ultrasound criteria to diagnose varicoceles: Iosa G, Lazzarini D. Hemodynamic classification of varicoceles in men: Valentino M, Bertolotto M, Derchi Here, Pavlica P.

Children and adults varicocele: Diamond DA, Gargollo PC, Caldamone AA. Current management principles for adolescent varicocele. Diamond DA, Zurakowski D, Bauer SB, Borer JG, Peters CA, Cilento BG, Jr, et al. Relationship of varicocele grade and testicular hypotrophy to semen parameters in adolescents.

Patil V, Shetty Varicele mesh iod, Das SK. Redefining the criteria for grading varicoceles based on reflux times: Elastography to assess the effect of varicoceles on testes: Geatti O, Gasparini D, Shapiro B. A comparison of scintigraphy, thermography, ultrasound and phlebography in grading of clinical varicocele. Merla A, Ledda A, Di Donato L, Romani GL. Assessment of the effects of varicocelectomy on the thermoregulatory control of the scrotum.

Kulis T, Kolaric D, Karlovic K, Knezevic M, Antonini S, Kastelan Z. Scrotal infrared digital thermography in assessment of varicocele — pilot study to assess diagnostic criteria. Mali WP, Varicele mesh iod HY, Arndt JW, Kremer J, Coolsaet BL, Schuur K. Hemodynamics of the varicocele. Correlation among the clinical, phlebographic and scintigraphic findings. Minayoshi K, Okada H, Fujisawa M, Yamasaki K, Kamidono S.

Hemo-dynamic evaluation of left testicular varicocele by scrotal scintigraphy. Fuse H, Nozaki T, Ohta S, Varicele mesh iod H. Sequential scrotal scintigraphy for the study of varicocele. Ahlberg NE, Bartley O, Chidekel N, Fritjofsson A. Phlebography in varicocele scroti.

Acta Radiol Diagn Stockh ; 4: Varicocele testis evaluated by CT-scanning. Lewis DS, Grimm LJ, Varicele mesh iod CY. Left renal vein compression as cause for varicocele: Arslan H, Etlik O, Ceylan K, Temizoz O, Harman M, Kavan M. Incidence of retro-aortic left renal vein and its relationship with varicocele. El-Saeity NS, Sidhu PS. Is this evidence based?

Chandramohan S, Chakravertry S. Diffusion-weighted MRI of the testes in patients with varicocele: Articles from Journal of Ultrasonography are provided here courtesy of Medical Communications Sp.

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