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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Transfemoral cannulation of renal vessels with the Seldinger technique has been used as well as routine angiography in the following urologic indications. 1. Hypothermic in situ perfusion of the kidney in difficult surgical procedures on the renal parenchyma, e.g., multiple stones, stag-horn calculi, benign and malignant tumors in solitary, residual or functionally residual kidneys. The advantages of this method are sufficient time for surgery, no contamination of blood and therefore excellent view by means of complete ischemia and good long-term results of the renal function. 2. Embolization of inoperable renal tumors to reduce tumor growth and control bleeding. The material used for embolization was a modified preparation of homogenized autologous muscle tissue. 3. Occlusion of the renal artery prior to tumor nephrectomy by a flow-guided balloon catheter in order to reduce the difficulty of the surgical produce, e.g., in massive carcinomatous infiltration of the hilus vessels. 4. Retrograde phlebography of the left internal spermatic vein in recurrent or persistent varicocele and in infertility with only insignificant or doubtful varicocele. The advantage compared with orthograde phlebography via plexus pampiniformis is the direct evidence that the venous reflux causes the varicocele. When the technique has been mastered transfemoral cannulation of the renal vessels can be used in routinely in the clinic Critical consideration of the indications, however, is necessary.
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PMID:[Transfemoral cannulation of the renal vessels. Diagnostic and therapeutic use in urology (author's transl)]. 84 52

Basic parameters of central and intracardiac hemodynamics were studied in 49 urological patients 24 of which with urolithiasis entered group I, 13 with hypertension-group II and 12 with varicocele-group III. The patients' age averaged 46.4, 41.6 and 28.6 years, respectively. The data were provided by routine clinical and laboratory examinations, ECG, one-passage radionuclide cardiography with 132I-albumin using a radiocirculographer of Hungarian manufacture and radiocardioanalyzer RKAZ-01 made in this country. Neither marked ischemic disturbances of the myocardium nor valvular defects were revealed. Ambiguous group-specific shifts presented in central and intracardiac hemodynamics. Total peripheral vascular resistance exhibited a moderate increase while left ventricular circulation time grew 1.5-2-fold. The greater resistance can be attributed to activation of renin-angiotensin system in prolonged ischemia of renal parenchyma due to nephrolithiasis. Group II patients demonstrated parallel elevation of arterial pressure, peripheral resistance, left ventricular performance and output suggesting myocardial functional stress. In group III there was a rise in blood volume, left ventricular performance and output, cardiac index, stroke volume. This myocardial overloading may result from changes in intravascular volumetric relations characteristic of hypervolemia. These hemodynamic changes reflect adaptation in urological patients and should be accounted for in treatment and operative interventions.
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PMID:[The radionuclide assessment of the central hemodynamic indices in patients with urolithiasis, arterial hypertension and varicocele]. 194 10

This study reports on the stagnation of blood within the microcirculatory vessels of the testes of patients with varicocele. Both fine structural and quantitative studies were carried out on testicular biopsies from 14 men with varicocele and a control group of three men. Arterioles, capillaries, and venules were completely filled with blood in all affected testes. Enlarged pores were also noticed between the endothelial cells of these affected vessels. Lumen diameters of the arterioles were significantly decreased in the affected testis compared to controls. No change in the overall diameter of the arterioles and venules was noted. Significant thickening of the limiting membrane was also noted in the affected testis. It was concluded that the stagnation of blood in the microcirculatory vessels may cause local hypoxia and ischemia, which lead to spermatogenic disorders.
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PMID:Stagnation of blood in the microcirculatory vessels in the testes of men with varicocele. 398 23

To study the postoperative recurrences of varicocele and the relationship between recurrences and sperm variables, we reexamined postoperatively 48 patients aged 14-56 years (mean: 25 years); the patients returned within a time range of 4 to 36 months. All the patients underwent physical examination, B-mode, color and power Doppler sonography (US); the images were acquired with the patient both supine and upright, both at rest and during Valsalva maneuver. We studied the incidence of recurrences and their bilaterality, the presence of reflux with or without functional maneuvers, associated conditions, surgical complications and the improvement of sperm variables; color and power Doppler findings were compared. The incidence of recurrences (28) and that of major complications (2) were related to the type of surgery: thus, no complications but 26 recurrences were found in the patients with spermatic vein ligation, versus only 2 recurrences but also 2 major complications (1 testicular ischemia and 1 hydrocele) in the patients with ligation of the spermatic cord venous channels. A right varicocele was found in 12 patients, which confirmed the frequent bilaterality of this condition; 8 patients with recurrences had improved sperm variables and 6 presented associated conditions. Our trial confirms that B-mode US, combined with color and power Doppler, can show recurrences, bilaterality, surgical complications and associated conditions and emphasize the role of these exams in the postoperative follow-up of varicocele. However, no method alone, without the evaluation of sperm variables, permits to select the patients to be reoperated on.
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PMID:[Assessment of varicocele recurrence with ultrasonography, color and power Doppler]. 928 Sep 40

Adolescents rarely consult for painful varicocele. The condition has to be confirmed by physical examination and a detailed Doppler exam. An ultrasound may be necessary to measure the size of the testis. About 15% of all adolescents have varicoceles. One out of three is graded II or III in the Dubin and Amelar classification. About 20% of varicoceles graded III occur in association with testicular hypotrophy. We do not know whether boys with a varicocele will fertility problems later on, but only 13% of adult men with varicocele are infertile. Surgery can be considered as necessary only after studying a large number of patients, comparing at random patients operated at a young age and followed for 15-20 years with patients not operated and with a group of healthy controls. The best treatment has to be selected because of the low risk of testicular atrophy and the disappearance of the varicocele in more than 90% of the cases. Inguinal root with microsurgery, and pre or intra-operative radiologic opacifications are the usual choice of most pediatric surgeons. Laparoscopy or retroperitoneoscopy have no major impact on the postoperative results. They are expensive and require great experience. Embolization and other radiological techniques induce a long period of radiation, are not always possible, expensive and demand an experienced radiologist. General anesthesia is required because of the time involved and finally the success rate is low. Microsurgical venous reanastomosis is still confidential probably because of technical difficulties. Scrotal anterograde sclerotherapy is the simplest and cheapest treatment and can be performed with a local anesthetic due to the short time required. But like other procedures, it can induce testicular ischemia.
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PMID:[Should varicoceles be treated in the adolescent? How?]. 1048 59

Ultrasonography (US) is a widely used and well tolerated imaging modality for evaluation of pathologic conditions of the testes. Recent technical advances of US applications and post processing developments have enabled new aspects in the structural and functional analysis of testicular tissue and therefore male fertility. This review covers the most relevant approaches due to recent technical advances. Testicular volume measured by B-mode US correlated significantly with testicular function. Increased resistive index (RI) and pulsatility index (PI) of capsular branches of testicular arteries on unenhanced color Doppler US examination may be an indicator of impaired testicular microcirculation in patients with clinical varicocele. FSH was inversely correlated with testicular volume and directly correlated with testicular vascularization, suggesting that ultrasonographic and color Doppler scanning of the testes may be used, if a sperm count is not available, to indirectly assess the gonadal function. Perfusion mapping, performed with the use of color Doppler ultrasound, has shown for the first time that in patients suffering from azoospermia, sperm quality and quantity depend on tissue perfusion within the testicle. Testicular arterial blood flow was found to be significantly decreased in men with varicocele. This may be a reflection of the impaired microcirculation. Following decreased testicular arterial blood flow, impaired spermatogenesis may result from defective energy metabolism in the microcirculatory bed. Contrast-enhanced ultrasound (CEUS) imaging is potentially applicable to the investigation of vascular disorders of the testis. Pulse inversion (PI) US data can correctly determine relative testicular perfusion based on nonlinear curve fitting of the US backscatter intensity as a function of time and spectral analysis of the intensity time trace. PI imaging, compared with conventional Doppler US methods, provides superior assessment of perfusion in the setting of acute testicular ischemia. New contrast-enhanced US techniques like microvessel imaging (proposed by Philips) and CPS (proposed by Siemens-Acuson) allow for a better determination of tissue perfusion based on time intensity curves and an illustration of vessel distribution inside the testis. First results show a lower vessel density in atrophic testes and a difference in contrast dynamics in testes with impaired function. Real-time elastography, a method for illustration of tissue stiffness under real-time conditions, demonstrates different elasticity values dependent on testicular volume and function. Further studies will prove if these techniques can evolve into clinical practice.
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PMID:The role of ultrasound in assessment of male fertility. 1930 91

The paper reviews the current knowledge on the use of Doppler ultrasound in disease of the testis and scrotal contents. The first part presents fundamentals on vascularization and normal Doppler appearance of the testis as well as examination technique. The review presents the applications of Doppler ultrasonography in the diagnosis of inflammation, torsion and ischemia, varicocele, venous thrombosis, tumors, hydrocele, trauma and assessing fertility disturbance.
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PMID:Doppler applications in testicular and scrotal disease. 2116 53

The ideal method for treatment of varicocele is still controversial. The techniques of inguinal and sub-inguinal ligation, although less invasive than "high" abdominal ligations (Palomo, Ivanissevich), have been less popular than the former ones. Up to now most authors have considered as mandatory microsurgical techniques for the ligation of spermatic veins at inguinal or sub-inguinal level, or at least instruments of optical magnification in order to preserve testicular arterial supply of the spermatic and cremasteric artery at groin and to prevent testicular atrophia or gonadic ischemia. The aim of this study was to assess clinical outcomes of open surgical technique of varicocele repair compared to results derived from microsurgical series. A retrospective study included 45 patients of mean age 31 years (range 18-39) that underwent open surgical technique of inguinal ligation of spermatic veins in the period 2004-2009; clinical results of this series were compared with those obtained in five relevant studies derived from systematic review of the literature on microsurgical techniques. The pre-operatory evaluation in our series included a physical examination, a minimum of two semen analysis and scrotal color Doppler ultrasound. Post-operative pain, complication rates, days of hospitalization and time to return to work were considered as main outcomes. All patients were evaluated at 1 week, at 3 and 6 months after the operation by means of a physical examination, scrotal Doppler ultrasound and sperm analysis. Most patients (39/45) presented no pain in the first week, 6/45 mild to moderate pain (mean VAS score 2). None of the patients reported pain in the weeks thereafter The hospitalization (1.8 +/- 0.7 days) and the time for return to work (7.2 +/- 3.2 days) were not significantly different in microsurgical and open groups. During follow-up no complications like hydrocele or testicular atrophy were observed. Doppler ultrasound carried out 3 and 6 months after surgery, pointed out no reflux in testicular veins in 41/45 cases while in 4/45 it showed a persistence of reflux grade I, less than the grade before the treatment. Comparing pre-and post-operatory sperm analysis allowed us to observe a significant improvement either in spermatozoa concentration (22 +/- 4 40_+/- 6 millions/ml, p < 0.01), either in motility (33 +/- 4% and 48 +/- 4%, p < 0.05), without significant changes in morphology. No significant differences were recorded comparing these data with those coming from microsurgical series. Our study reported positive clinical outcomes using the technique of sub-inguinal surgical ligature of varicocele without using microsurgical techniques or instruments of optical magnification. The operative time, complication and relapse rates, Doppler flow parameters and semen parameters were not significantly different from those reported in the literature of microsurgical techniques, with the advantage of such a simple surgical technique combined with cost savings and patient's comfort.
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PMID:Is microsurgical technique really necessary in inguinal or sub-inguinal surgical treatment of varicocele? 2182 77

Varicocele is the most common and surgically correctible cause of male infertility in men attending to infertility clinics. Infertility affects 15% of all couples and male factor is the primary or contributing cause in 40% to 60% of cases. Varicocele has been shown to cause male infertility in about 15% of infertile couples. Molecular mechanisms responsible from varicocele induced testicular dysfunction and male infertility have not been completely unknown. Recent years have witnessed a huge amount of scientific works devoted to the mechanism of varicocele associated male infertility and rapid progress in research on its cellular and molecular mechanisms, including apoptosis and oxidative stress of germ cells. Here we evaluated internal spermatic vein and brachal vein ischemia modified albumin (IMA) level in 40 adult male patients with varicocele. IMA level was analyzed using albumin cobalt-binding test. Spermatic vein and brachial vein IMA levels were 0.381 &plusmn; 0.135 ABSU (absorbance units) and 0.385 &plusmn; 0.131 ABSU, respectively. There was no statistically significant difference between the two areas. IMA levels in the internal spermatic vein of patients with varicocele should not be used as a marker of hypoxia.
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PMID:Lack of significant difference between internal spermatic vein and brachial vein ischemia modified albumin levels in patients with varicocele. 2369 3

Testicular compartment syndrome (TCS) refers to the impairment of microcirculation in the testicle due to either increased venous resistance or extraluminal compression, which leads to hypoxia. TCS releases oxidants through hypoxia and ischemia/reperfusion injury (IRI). The pathophysiology, etiology, evaluation, and management of TCS are reviewed. Based on the properties of TCS, specific causes, e.g., varicocele, hydrocele, orchitis, cryptorchidism, and scrotal hernia, are suggested and categorized. The oxidant-induced stress from TCS may explain the correlations between these causes and infertility. A chief shortcoming of current imaging modalities is that they detect TCS late after it has progressed to impair the macrocirculation of the testicle. We propose frequent sequential periodic power Doppler ultrasonography to monitoring for earlier detection. Intraoperatively, TCS can be diagnosed by the dull purple appearance of a hypoxic testicle and by tissue pressures above 30 mmHg. When compartment pressure is low, the underlying etiology must be promptly treated. During acute presentation, an incision of the resilient tunica albuginea may be necessary. A great challenge of treating TCS is restoring microcirculation while minimizing IRI; concomitant antioxidant therapy secondary to treatment may be effective and harmless at the least. Because testicular oxidant stress is common in infertility and since TCS can cause such a stress, TCS may be a larger factor in infertility than currently suspected.
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PMID:Testicular compartment syndrome: an overview of pathophysiology, etiology, evaluation, and management. 2807 25


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