الفهرس | Only 14 pages are availabe for public view |
Abstract Variocele is a common clinical condition with vast importance in reproductive medicine practice , being Found in 15% of male population ,35% in those presented with primary infertility , and 80 % in those with secondary infertility. Varicocele is defined as dilated pampiniform plexus of veins which drains the testicles , Normal caliber of the pampiniform plexus of veins ranges from 0.5 -1.5 mm , if the diameter exceeds 2 mm , the diagnosis of varicocele is made. Varicocele diagnosis is a multi-disciplinary process , involving physical examination by palpating the scrotal sac , color Doppler examination which has a sensitivity of 97% and then the assessment of varicocele effect on semen analysis and other laboratory parameters . The indications of non medical intervention for clinically significant varicocele include infertility or subfertility specially with impaired semen parameters , hypogonadism, scrotal pain, and testicular atrophy .Treatment options for varicocele can be divided into two major categories: (1) percutaneous occlusion, by intravenous injection of various materials to occlude the varicoceles and (2) surgical ligation or clipping of the varicoceles to prevent venous reflux. Surgical treatment, has represented the elective method of treatment of varicocele for decades , yet because of the high frequency of venous collaterals, surgery is associated with recurrence of the disease or persistence of venous reflux in the pampiniform plexus in 0%–28% of patients. Varicocele treatment by percutaneous embolization of the internal spermatic vein is a safe and effective minimally invasive procedure. Its very low morbidity and complication rates, high long-term rates of success and demonstrated cost effectiveness relative to surgery have led many authors to believe that it should have the upper hand over surgical option or at least a valuable alternative to it . |