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Résultats hémodynamiques et cliniques de la dissection, assistée par lunettes chirurgicales, des veines spermatiques au niveau de l’orifice inguinal interne

Haemodynamic results and complications after dissection of the spermatic vein in the internal inguinal ring with a 4.5 × operating microscope

Andrologie volume 12, pages 357–360 (2002)Cite this article

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Le reflux veineux réno-spermatique est très bien démontré par l’échographie couleur doppler (ECCD) et il est l’élément hémodynamique de base de la varicocèle. Nous avons essayé de vérifier l’utilité de la dissection, avec des lunettes chirurgicales permettant un grossissement de 4,5 des branches de la veine spermatique au niveau de l’orifice inguinal interne.

16 patients ont été opérés selon la classification échographique de Hirsh et al. [8]. La varicocèle était du IIIe degré pour 2 cas, du IVe degré pour 11 cas et du Ve degré pour 3 cas. La varicocèle était à gauche chez 13 patients et à droite dans 3 cas.

Le diagnostic a été réalisé par examen clinique et ECCD. Le temps opératoire était de 25–35 min. L’incision avait 1,5 à 2 cm de long. Nous n’avons jamais eu de complications à court terme, ni d’hydrocèle à long terme. L’ECCD après six mois n’a pas trouvé de reflux réno-spermatique. Le volume testiculaire moyen qui était de 22 ml avant, ne changeait pas après l’intervention chirurgicale.

Cette intervention chirurgicale est moins invasive que l’intervention rétro-péritonéale classique ou laparoscopique, et l’abord chirurgical est moins important respectivement à la technique percutanée; elle est moins radicale que l’intervention en microchirurgie classique, mais le temps opératoire est plus bref, et la plaie chirurgicale est plus petite; elle respecte l’artère et les vaisseaux lymphatiques.

En conclusion, cette intervention peut être considérée comme une bonne option dans le traitement chirurgical de la varicocéle parce qu’elle a peu de complications, une absence d’hydrocèle, une importance chirurgicale limitée et permet des bons résultats hémodynamiques.

Abstract

Inversion of venous flow is well visualized by colour duplex ultrasound and is the basic haemodynamic feature of varicocele. We tried to assess the value of dissection of branches of the spermatic vein in the internal inguinal ring using an operating microscope with a magnification of 4.5x.

16 patients were operated according to the ultrasound classification proposed by Hirsh et al. [8]. Varicocele was grade III in 2 cases, grade IV in 11 cases and grade V in 3 cases and was situated on the left in 13 patients and on the right in 3 patients.

The diagnosis was based on clinical examination and colour duplex ultrasound. The operating time was 25–35 min. The incision was 1.5 to 2 cm long. No short-term complications or long-term hydrocele were observed. No reno-spermatic flow was observed on colour duplex ultrasound after six months. The mean testicular volume was 22 ml before surgery and did not change after the operation.

This surgical technique is less invasive than the conventional retroperitoneal or laparoscopic procedures, and the incision is smaller than with the percutaneous technique. It is less radical than conventional microsurgery, but the operating time is shorter, and the surgical wound is smaller, sparing the artery and lymphatic vessels.

In conclusion, this operation can be considered to be a good option in the surgical treatment of varicocele in view of its low complication rate, the absence of hydrocele, a minimally invasive procedure and the good haemodynamic results.

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Authors and Affiliations

  1. Service d’Urologie Andrologie, Hôpital “Misericordia”, Rue Oberdan 44, 58100, Grosseto, Italie

    Giandomenico Passavanti, Valerio Pizzuti, Fabio Massimo Costantini & Riccardo Paolini

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  1. Giandomenico Passavanti
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  2. Valerio Pizzuti
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  3. Fabio Massimo Costantini
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Correspondence to Giandomenico Passavanti.

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Passavanti, G., Pizzuti, V., Costantini, F.M. et al. Résultats hémodynamiques et cliniques de la dissection, assistée par lunettes chirurgicales, des veines spermatiques au niveau de l’orifice inguinal interne. Androl. 12, 357–360 (2002). https://doi.org/10.1007/BF03034654

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Basic and Clinical Andrology

ISSN: 2051-4190