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Internal spermatic vein insufficiency in varicoceles: a different entity in adults and adolescents?

Peter Vanlangenhove, Elisabeth Dhondt, GEORGES VAN MAELE, Sofie Van Waesberghe, ELLEN DELANGHE and Luc Defreyne UGent (2015) AMERICAN JOURNAL OF ROENTGENOLOGY. 205(3). p.667-675
abstract
OBJECTIVE. The purpose of this study was to determine whether phlebographic features can be used to discriminate adult from adolescent varicocele. MATERIALS AND METHODS. Left and right internal spermatic venograms of 191 adolescents (< 17 years) and 224 adults (>= 25 years) were anonymized and evaluated. Phlebographic radioanatomic features (valves, duplications, collaterals, and classifications) were compared and analyzed with univariate tests. RESULTS. Insufficiency of the left internal spermatic vein (ISV) was confirmed in 409 of the 415 (99%) patients. Adults had no spontaneous opacification of the ISV during venography twice as frequently as adolescents (p = 0.001), a complex outflow into the renal vein 2.2 times as often (p = 0.021), and significantly more collaterals (p = 0.030). Adolescents had a significantly lower number of competent valves and significantly more instances of nutcracker phenomenon (p = 0.001). According to the Bahren classification, the distribution of the types of ISVs was significantly different between adults and adolescents (p = 0.009). Insufficiency of the right ISV was encountered 2.4 times as frequently in adults as in adolescents (p < 0.001). In adults the maximum diameter of the ISV was significantly larger (p = 0.023). Bilateral ISV insufficiency was 2.2 times as frequent in adults (p < 0.001) as in adolescents. CONCLUSION. Left-sided varicoceles in adults are distinct from those in adolescents. In adults, reflux is likely to be induced via collateral pathways, whereas in adolescents congenital venous abnormalities are predominantly present. The higher prevalence and the greater diameter of a right insufficient ISV in adults, combined with the absence of venous anatomic differences, supports the hypothesis that right-sided varicocele is an evolutive disease.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
PERCUTANEOUS SCLEROTHERAPY, varicocele-adolescents-adults-phlebography-pathophysiology, IDIOPATHIC VARICOCELES, NUTCRACKER SYNDROME, TESTICULAR VOLUME, MEN, CHILDREN, EMBOLIZATION, PHLEBOGRAPHY, INFERTILITY, HEMATURIA
journal title
AMERICAN JOURNAL OF ROENTGENOLOGY
Am. J. Roentgenol.
volume
205
issue
3
pages
667 - 675
Web of Science type
Article
Web of Science id
000359997100050
JCR category
RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
JCR impact factor
2.66 (2015)
JCR rank
34/124 (2015)
JCR quartile
2 (2015)
ISSN
0361-803X
DOI
10.2214/AJR.14.14085
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
7140324
handle
http://hdl.handle.net/1854/LU-7140324
date created
2016-03-09 14:03:51
date last changed
2016-12-19 15:45:37
@article{7140324,
  abstract     = {OBJECTIVE. The purpose of this study was to determine whether phlebographic features can be used to discriminate adult from adolescent varicocele. 
MATERIALS AND METHODS. Left and right internal spermatic venograms of 191 adolescents ({\textlangle} 17 years) and 224 adults ({\textrangle}= 25 years) were anonymized and evaluated. Phlebographic radioanatomic features (valves, duplications, collaterals, and classifications) were compared and analyzed with univariate tests. 
RESULTS. Insufficiency of the left internal spermatic vein (ISV) was confirmed in 409 of the 415 (99\%) patients. Adults had no spontaneous opacification of the ISV during venography twice as frequently as adolescents (p = 0.001), a complex outflow into the renal vein 2.2 times as often (p = 0.021), and significantly more collaterals (p = 0.030). Adolescents had a significantly lower number of competent valves and significantly more instances of nutcracker phenomenon (p = 0.001). According to the Bahren classification, the distribution of the types of ISVs was significantly different between adults and adolescents (p = 0.009). Insufficiency of the right ISV was encountered 2.4 times as frequently in adults as in adolescents (p {\textlangle} 0.001). In adults the maximum diameter of the ISV was significantly larger (p = 0.023). Bilateral ISV insufficiency was 2.2 times as frequent in adults (p {\textlangle} 0.001) as in adolescents. 
CONCLUSION. Left-sided varicoceles in adults are distinct from those in adolescents. In adults, reflux is likely to be induced via collateral pathways, whereas in adolescents congenital venous abnormalities are predominantly present. The higher prevalence and the greater diameter of a right insufficient ISV in adults, combined with the absence of venous anatomic differences, supports the hypothesis that right-sided varicocele is an evolutive disease.},
  author       = {Vanlangenhove, Peter and Dhondt, Elisabeth and VAN MAELE, GEORGES and Van Waesberghe, Sofie and DELANGHE, ELLEN and Defreyne, Luc},
  issn         = {0361-803X},
  journal      = {AMERICAN JOURNAL OF ROENTGENOLOGY},
  keyword      = {PERCUTANEOUS SCLEROTHERAPY,varicocele-adolescents-adults-phlebography-pathophysiology,IDIOPATHIC VARICOCELES,NUTCRACKER SYNDROME,TESTICULAR VOLUME,MEN,CHILDREN,EMBOLIZATION,PHLEBOGRAPHY,INFERTILITY,HEMATURIA},
  language     = {eng},
  number       = {3},
  pages        = {667--675},
  title        = {Internal spermatic vein insufficiency in varicoceles: a different entity in adults and adolescents?},
  url          = {http://dx.doi.org/10.2214/AJR.14.14085},
  volume       = {205},
  year         = {2015},
}

Chicago
VANLANGENHOVE, PETER, ELISABETH DHONDT, GEORGES VAN MAELE, Sofie Van Waesberghe, ELLEN DELANGHE, and Luc Defreyne. 2015. “Internal Spermatic Vein Insufficiency in Varicoceles: a Different Entity in Adults and Adolescents?” American Journal of Roentgenology 205 (3): 667–675.
APA
VANLANGENHOVE, PETER, DHONDT, E., VAN MAELE, G., Van Waesberghe, S., DELANGHE, E., & Defreyne, L. (2015). Internal spermatic vein insufficiency in varicoceles: a different entity in adults and adolescents? AMERICAN JOURNAL OF ROENTGENOLOGY, 205(3), 667–675.
Vancouver
1.
VANLANGENHOVE P, DHONDT E, VAN MAELE G, Van Waesberghe S, DELANGHE E, Defreyne L. Internal spermatic vein insufficiency in varicoceles: a different entity in adults and adolescents? AMERICAN JOURNAL OF ROENTGENOLOGY. 2015;205(3):667–75.
MLA
VANLANGENHOVE, PETER, ELISABETH DHONDT, GEORGES VAN MAELE, et al. “Internal Spermatic Vein Insufficiency in Varicoceles: a Different Entity in Adults and Adolescents?” AMERICAN JOURNAL OF ROENTGENOLOGY 205.3 (2015): 667–675. Print.