[Andrological aspects of varicocele surgery in teenagers].
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Biomedical subjects
Publications and source records attributed to V T Kondakov.
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On the basis of the results of rheotesticulographic studies in 38 children with left-sided II-III degree varicocele, the impairment in hemodynamics in the testicle at the involved side was established. No suppression of androgen function of the organ was revealed. The expediency to perform in patients of pediatric and young age the Ivanissevich operation, the effectiveness of which is increased in use of intraoperative phlebotesticulography was noted. The effective method for varicocele treatment in children has been suggested. The testicular vein is ligated near the deep inguinal ring as well as at the level of the upper third, then it is excised between the ligatures together with the deviating branches. The method was used in treatment of 120 patients with II-III degree varicocele. No disease recurrence is noted during 1.5 years.
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The operation is aimed at embolization of all the varicose veins of the gastroesophageal zone which are the source of bleeding in portal hypertension. Under the corresponding anatomical conditions the total embolization results in the decreased portal tension due to the development of effective direct portocaval anastomoses.
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Biopsies of veins of 20 boys with varicocele were studied morphologically. Three types of veins were observed. The first type was represented by veins with a wide lumen and the wall consisting of three layers of smooth muscle cells. The second morphological variant--veins of varying diameter of irregular shape and thin, frequently sclerosed wall. The third type were veins of a small diameter with well developed muscular layer. Immunohistochemical studies detected disturbances of vascular wall components suggesting the development of varicocele as a complex of congenital pathology with secondary alteration and destabilisation of compensatory processes.
The paper is concerned with analysis of the results of intraoperative phlebotesticulography, performed in 50 patients with varicocele of degree I-II during Ivanissevich's operation. The effect of surgical intervention was shown to depend upon the quality of ligation of the testicular vein, some parts of which are anastomosed between themselves. The localization of this anastomosis is revealed by means of intraoperative phlebotesticulography, which permits increasing the results of surgical treatment and predicting a course of a postoperative period.
Ninety-five children with different forms of hermaphroditism aged 3 months to 14 years were examined to assess the potentialities of echography. Ultrasonic examinations of the kidneys, adrenals, pelvic organs (with full bladder, during and after miction), scrotum, and inguinal area were carried out. Echographic picture of urogenital organs in mixed ovarian dysgenesis, congenital deficiency of testosterone biosynthesis or metabolism due to enzymatic deficit, testicular feminization, congenital adrenocortical dysfunction was analyzed and criteria of differential diagnosis of these conditions discussed. The informative value of the method was assessed. Ultrasonic findings were compared with the data other diagnostic methods and reliability and high sensitivity of ultrasonography was demonstrated.