Scrotal varicocele : New classification ? And what to do? M.F. SUKKARIEH M.D.

What is varicocele ? A varicocele is widening of the veins along the cord that holds up a man”s Testicules (spermatic cord )

Echo doppler: Varicocele Pathologic enlargement, elongation and wriggler of pampeniformis plexus ( varicocele of spermatic cord ) 3% Right side 16% Bilateral 80-90% Left side Echo doppler: 59% right side in valsava 83% left side

( NORMAL ) Spermatic vein Drains in to the renal vein By SPERMATIC CORD VARICOCELE ( NORMAL )

After two times Of varicocelectomy

Spermatic vein by epididymal varicocele

After ligation of the spermatic Vein in sub inguinal incision SUKKARIEH OP.

Spermatic vein By Epididymal Varicocele Drains in to the common iliac vein.

I think and believe : that the eco-doppler Of testis should include the inguinal canal too.

Persistent varicocele -15% post high ligation -3 to 5% post ante grade sclerotherapy

New Classification for scrotal varicocele -Spermatic cord varicocele: GI : Varicocle palpable with valsava maneuver only GII: palpable in the standing position GIII: Visually apparent through the scrotal skin as a “bag of worms” -Epididymal varicocele G1,G2,G3 (scrotal varicocele with normal spermatic cord) Subclinical varicocele by echo doppler

Operations Bernardi Palomo Ivanessevich Narath cocher Micro surgery Laparoscopic Retrograde embolisation of the spermatic vein Antegrade sclerotherapy of the plexus pampeniformis – Tauber (scrotal incision ) _ Sukkarieh ( sub inguinal incision) _Sukkarieh op. for Epididymal varicocele

Tauber : Scrotal incision

Sukkarieh ; Sub inguinal incision

Microsurgery incision Sub inguinal incision

(Ante grade sclero therapy ) Organisation of the plexus pampiniformis after the injection of the sclerotic agent (intraluminal microembolisation of the plexus}

Varicocele what to do? - Retroperitoneal ligation of spermatic vein.Bernardi op. in Palomo incision for clincal G3 varicocele and in children. Ligation of the big spermatic vein in sub inguinal incision for EPIDIDYMAL varicocele ( Sukkarieh op.) - ANTE GRADE SCLEROTHERAPY( MICRO EMBOLISATION OF PLEXUS PAMPINIFORMIS ( Tauber op. by sukkarieh tech.) FOR: 1-Varicocele G1, G2 ,and G3 by eco-doppler. 2-Subclinical varicocele. 3-Persistent of varicocele post high ligation, (NOT EPIDIDYMAL VARICOCELE ).

THANK YOU