Changes in the appearance of venography after ligation of a varicocele
Hill, J.T.; Hirsh, A.V.; Pryor, J.P.; Kellett, M.J.
Journal of Anatomy 135(Pt 1): 47-52
1982
ISSN/ISBN: 0021-8782 PMID: 7130055 Document Number: 183055
Twenty-four with a clinical varicocele were assessed by ascending scrotal venography before and after surgical ligation of the testicular veins and the cremasteric veins. The venous drainage was extensive with considerable collateral circulation. After ligation, the direction of venous return was unchanged in 9 patients, diverted to known collateral channels in 8 patients and diverted to collateral channels which was not seen on the pre-ligation venogram in 7 patients. The most commonly observed vein on the post ligation venogram was the superficial external pudendal (63% of the patients) followed by the cremasteric (46%), testicular (38%) and the contralateral communications with the opposite pampiniform plexus (38%). There were no patients with total failure of venous return after ligation suggesting that the risk of testicular atrophy after surgery was unlikely. Although a free communication between the venous drainage of the epididymis and the prostatic venous plexus was previously demonstrated in the rat, there was no evidence of a similar communication in this study. Failed surgery in the treatment of varicocele may be explained by the finding that the direction of venous return after ligation remains unchanged in some patients. The role played by the superficial external pudendal vein in the etiology of varicocele requires further assessment by retrograde venography.