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.

Increased expression of the sonic hedgehog and vascular endothelial growth factor with co-localization in varicocele veins

Objectives Varicocele is characterized by dilatation and tortuosity of the internal spermatic vein. Sonic hedgehog plays an important role in angiogenesis and vascular remodeling under hypoxic stress. We studied the relationship and distribution of SHH and vascular endothelial growth factor in internal spermatic vein in patients diagnosed with varicocele. Methods Specimens of 1 cm were taken from the internal spermatic vein during left varicocele repair (N = 20). The control samples of ISV were obtained from eight male patients who underwent left inguinal herniorrhaphy. We analyzed the sonic hedgehog and vascular endothelial growth factor expression and distribution by immunoblotting, immunohistochemistry, immunofluorescent staining, and confocal laser scanning microscopy. The data were analyzed using the Student’s t test. Results Immunoblotting showed higher expression of sonic hedgehog and vascular endothelial growth factor proteins in varicocele veins than in the control group ( P < 0.05) which located over muscle layer and endothelium was demonstrated by immunohistochemical staining. Both proteins with co-localization in the muscle layer and especially distributed in endothelium of varicocele veins were revealed under confocal microscopy. Conclusions These findings showed the upexpression of sonic hedgehog and vascular endothelial growth factor with co-localization in varicocele veins which imply that the reducing hypoxia or using sonic hedgehog antagonists may be helpful for this vascular disease.

Lack of significant difference between internal spermatic vein and brachial vein ischemia modified albumin levels in patients with varicocele

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.