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

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

3. 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

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

5. After two times
Of varicocelectomy

10. Spermatic vein by epididymal
varicocele

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

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

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

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

17. 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

18. 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

21. Tauber :
Scrotal incision

22. Sukkarieh ;
Sub inguinal
incision

23. Microsurgery incision
Sub inguinal incision

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

25. 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 ).

26. THANK YOU