Thrombosis of Right Spermatic Vein: A Case Report

Spermatic vein thrombosis is a rare event that mostly affects the left vein thrombosis, but, in our report, it had developed on the right one that requires a meticulous physical examination for diagnosis. The purpose of this case report is to introduce an adult patient with right spermatic vein thrombosis in a 30-year-old man admitted to the operating room for hernia surgery. Spermatic vein thrombosis is an unexpected finding in the differential diagnosis of acute testicular pain.

Production of 11-oxygenated androgens by testicular adrenal rest tumors

Context Testicular adrenal rest tumors (TART) are a common complication in males with classic 21-hydroxylase deficiency (21OHD). TART are likely to contribute to the androgen excess in 21OHD patients, but a direct quantification of steroidogenesis from these tumors has not been yet done. Objective Define the production of 11-oxygenated 19-carbon (11oxC19) steroids by TART. Participants and methods Steroids were measured in left (n=7) and right (n=4) spermatic vein- and simultaneously taken peripheral blood (n=7) samples from seven men with 21OHD and TART using liquid chromatography-tandem mass spectrometry. For comparison, we also measured the peripheral steroid concentrations in five adrenalectomized patients and twelve age- and BMI-matched controls. Additionally, steroids were quantified in TART cell- and adrenal cell-conditioned medium, with and without adrenocorticotropic hormone (ACTH) stimulation. Results Compared to peripheral blood of 21OHD patients with TART, the spermatic vein samples displayed the highest gradient for 11β-hydroxytestosterone (11OHT; 96-fold) of the 11oxC19 steroids, followed by 11-ketotestosterone (47-fold) and 11β-hydroxyandrostenedione (11OHA4; 29-fold), suggesting production of these steroids in TART. TART cells produced higher levels of testosterone, and lower levels of A4 and 11OHA4 after ACTH stimulation compared to adrenal cells, indicating ACTH-induced production of testosterone in TART. Conclusion In patients with 21OHD, TART produce 11oxC19 steroids, but in different proportions than the adrenals. The very high ratio of 11OHT in spermatic- versus peripheral vein blood suggests the 11-hydroxylation of testosterone by TART, and the in vitro results indicate that this metabolism is ACTH-sensitive.

Tauber antegrade sclerotherapy: the importance of phlebography in choosing the correct vein.

Tauber antegrade sclerotherapy can be considered an established procedure for the treatment of varicocele in paediatric age. Herein, we share our experience with this technique and its tricks. The choice of the spermatic vein should be very accurate during the Tauber procedure, and a correct intraoperative phlebography is mandatory to avoid complications.

Tauber antegrade sclerotherapy: the importance of phlebography in choosing the correct vein.

Tauber antegrade sclerotherapy can be considered an established procedure for the treatment of varicocele in pediatric age. Herein, we share our experience with this technique and its tricks. The choice of the spermatic vein should be very accurate during the Tauber procedure, and a correct intraoperative phlebography is mandatory to avoid complications.

Spermatic vein embolization as a treatment for symptomatic varicocele

Introduction: Varicocele is a relatively common condition in men that causes pain in approximately 10% of cases. There have been few studies to date assessing the improvements in both pain and quality of life parameters associated with spermatic vein embolization (SVE) as a treatment for patients with symptomatic varicocele, so we aimed to assess this. Methods: A review was carried out of consecutive SVE procedures performed at our institution from 2013–2019. Only patients with painful varicocele were included after other causes of testicular pain were excluded. The technique employed was a combination of distal coil embolization of the spermatic vein with 4–6 mm coils at the level of the inguinal canal, as well as sclerotherapy to prevent reflux of sclerosant. Furthermore, a prospective validated Pain Impact Questionnaire-6 (PIQ-6) was performed to assess for improvement in quality of life. A matched pair Student two-tailed t-test was used to compare mean scores pre- and post-treatment, with 95% confidence intervals presented as T scores and their associated p-values. Results: Over six years, 62 SVE procedures were performed for symptomatic varicocele. Success rate was 95%, with a median followup of nine months. Two patients had a failed procedure on two occasions requiring subsequent surgical ligation. There was one clinically significant recurrence. All components of PIQ-6 score showed a statistically significant reduction post-SVE, most noticeably pain severity and impact on leisure activities. Conclusions: SVE is a safe, effective, and well-tolerated treatment for symptomatic varicocele, improving pain and quality of life.

Production of 11-Oxygenated Androgens by Testicular Adrenal Rest Tumors

Testicular adrenal rest tumors (TART) are a common complication in male patients with classic 21-hydroxylase deficiency (21OHD). TART are considered to have steroid-producing properties and may contribute to the androgen excess in 21OHD patients. This study aims to define the production of 11-oxygenated 19-carbon (11oxC19) steroids by TART. Steroids were measured in left (n=7) and right (n=4) spermatic vein- and simultaneously taken peripheral plasma (n=7) samples from seven men with 21OHD and TART using liquid chromatography-tandem mass spectrometry. In addition, steroids were quantified in TART cell- and adrenal cell-conditioned medium, with and without adrenocorticotropic hormone (ACTH) stimulation. Compared to peripheral blood of 21OHD patients with TART, the spermatic vein samples displayed the highest gradient for 11-hydroxytestosterone (11OHT; 96-fold) of the 11oxC19 steroids, followed by 11-ketotestosterone (47-fold) and 11-hydroxyandrostenedione (11OHA4; 29-fold), suggesting production of these steroids in TART. TART cell-conditioned medium contained higher levels of testosterone, and lower levels of androstenedione and 11OHA4 after ACTH stimulation compared to adrenal cell-conditioned medium, indicating ACTH-induced production of testosterone in TART. TART cells also produced 11OHT after 48 h of ACTH stimulation. Thus, in patients with 21OHD, TART produce 11oxC19 steroids, but in different proportions than the adrenals. The very high ratio of 11OHT in spermatic vein- versus peripheral vein blood suggests the 11-hydroxylation of testosterone by TART, and the in-vitro results indicate that this metabolism is ACTH-sensitive.

A rare case of right-sided varicocele in right renal tumor in the absence of venous thrombosis and IVC compression

Background The presence of unilateral right-sided varicocele hints at a serious retroperitoneal disease such as renal cell neoplasm. Such tumors are usually associated with a thrombus in renal vein or spermatic vein. We report a rare presentation of right-sided renal tumor causing right-sided varicocele in the absence of thrombus in renal vein and spermatic vein but due to an anomalous vein draining from the tumor into the spermatic vein as demonstrated by computed tomography angiogram. Case presentation A 54-yr-old hypertensive male presented with unilateral grade 3 right-sided varicocele and no other signs and symptoms. Ultrasound examination of his abdomen showed the presence of a mass lesion in the lower pole of right kidney. Computed tomography confirmed the presence of right renal mass, absence of thrombus in right renal vein or inferior vena cava. The angiographic phase of CT scan showed an anomalous vein from the tumor draining into the pampiniform plexus causing varicocele. Conclusion The presence of right-sided varicocele should raise a suspicion hidden serious pathological retroperitoneal condition, renal malignancy in particular, and should prompt the treating physician to carry out imaging studies of the retroperitoneum and careful study of the angiographic phase of the CT scan can ascertain the pathogenesis of the varicocele.

Blood flow condition in the left renal vein in operative treatment of patients with varicocele

The purpose of the study was to evaluate the blood flow in the left renal vein after ligation of the internal spermatic vein with varicocele and to study the changing of the level of biological markers of acute kidney damage in these patients. Materials and methods. Under observation were 64 men in age 1823 years with the first hemodynamic type of varicocele. In 3 patients clinically significant compression of the left renal vein was revealed and the remaining 61 patients underwent surgery by Ivanissevich approach. Before the operation, on the 2nd, 10th, 30th and 90th days after the operation patients underwent Doppler blood flow rate by ultrasound with color mapping of the left renal vein with measurement of venous blood flow velocity. During these periods all patients underwent laboratory tests, including the study of the content of cystatin C and interleukin 18 in the blood and urine. Results. On the first day after ligation of the internal spermatic vein an increase in the concentration of biological markers of acute kidney damage in the blood and urine was noted. After surgery all patients showed an increase in the diameter of the left renal vein by 1.52 mm and a decrease in the linear blood flow velocity in the region of the renal vien by 56 cm/s. On the 10th day after the operation the diameter of the left renal vein was increasesd by 34 mm more and the linear blood flow velocity slows down by 22.5 cm/s. The restoration of blood flow velocity and the diameter of the left renal vein occurred within three months and in most cases returned to baseline and in 22.9% of patients recovery did not occur by the 90th day of observation. Conclusion. Ligation of the internal spermatic vein with varicocele is accompanied by impaired blood flow in the left renal vein and an increase in the concentration of biological markers of acute kidney damage, which is a manifestation of venous hypertension and renal hypoxia. In most patients these indicators normalize to the 90th day of observation after surgery.