Urology and Andrology

The role of connective tissue dysplasia in the development of varicocele and its postoperative recurrence

Objective. Establishment of relationships between the severity of connective tissue dysplasia and the character of morphological changes in the testicular vein, associated with the presence of multiple small satellite veins in patients with a high risk of developing varicocele recurrence in clinically significant moderate/severe dysplasia.
Patients and methods. The subjects of study were 38 patients with left-sided varicocele, whose average age was 16.04 ± 0.83 years. The diagnosis of connective tissue dysplasia (CTD) was based on determination in these patients of the phenotypic and visceral markers of dysplasia, united in major clinical syndromes.
Results. According to the findings of morphological examination, the structure of TV with the only major vessels affected was found in 5 (13.16 ± 5.55%) operated patients. In 23 (60.53%) patients small, sometimes absolutely thread-like, satellite veins could be seen in the circumference of TV trunks. In 10 (26.31%) patients, TV during surgery looked like multiple thin-walled, closely adjacent and intertwining purple vessels, the diameter of which basically did not exceed 3 mm.
Conclusion. Difficult visualization of small veins during surgical intervention is, in our opinion, the main factor of development of varicocele recurrence. Based on the obtained clinical and morphological data we proposed a method of assessing a risk of developing recurrence of varicocele. The study permitted to single out patients with a high risk of developing disease recurrence, in whom many small satellite veins can be determined in the circumference of TV trunks. This group included patients with
clinically significant moderate/severe CTD, especially in its marked form.
Key words: varicocele recurrence, connective tissue dysplasia, testicular vein, satellite veins.
For citation: Andreev R.Yu., Rasner P.I., Prilepskaya E.A., Semenyakin I.V.,  Malkhasyan V.A., Pushkar D.Yu. The role of connective tissue dysplasia in  the development of varicocele and its postoperative recurrence. Vopr. urol. androl. (Urology and Andrology). 2019; 7(3): 29–34. (In Russian). DOI: 10.20953/2307-6631-2019-3-29-34