EFFICACY OF SPERMATIC VEIN

LIGATION IN PATIENTS AFFECTED BY

HIGH GRADE LEFT VARICOCELE
Pembimbing :
Prof. DR. dr. H. Rifki Muslim, Sp. B, Sp. U

Oleh :
Astri Noor Malitasari 30101206570

Kepanitraan Klinik Ilmu Bedah

RSI Sultan Agung Semarang
2018
 JOURNAL IDENTITY

Title • Efficacy of Spermatic Vein Ligation in Patients

Affected by High Grade Left Varicocele

• Marco Grasso, Caterina Lania, Salvatore

Authors Blanco, Silvia Confalonieri, Angelica A. C.
Grasso

Date of • February 2014

published

Published by • International Brazilian Journal Urology

 INTRODUCTION

The exact
association
between
reduced male
Varicocele  The condition is fertility and
elongation and 20-24% in the more common in varicocele is not
enlargement of adult male men in infertile known because
the network of population with marriages, in prospective
veins leaving a higher which it affects randomized
the testis that prevalence in 25-40% of men studies on
join to form the the left side. with abnormal varicocele
testicular vein. semen analysis treatment in
adults have
given conflicting
resus
MATERIALS & METHODS
Inclusion criteria:
From January 2006 to • infertility persisting for more
February 2011 than 1 year despite regular,
unprotected intercourse;
high grade left • abnormal semen parameters as
varicocele who assessed by World Health
presented with infertility Organiza-tion (WHO) guidelines
2010;

Exclusions :
• other infertility-related disease : :
history of maldescended testis,
infections, general diseases, or
chronic medication 75 patients.
• obvious causes of infertility in the
subject’s partner : anovulation,
endometriosis, tubal blockage
 All men underwent a standard diagnostic infertility evaluation
physical examination, blood tests, including hormonal dosages and testing for Y deletion
and chromosomal defects when needed according to seminal and clinical features, ecocolor
Doppler ultrasound of the scrotum

2 preoperative semen analyses (by masturbation after 3 days of

abstinence from sexual activity)

Waiting list 6-9 months ( to complete examination, unprotected

intercourse during the ovulation period in order to maximize the
probability of getting pregnant during the 6 months before
intervention)
 spermatic vein ligature through an inguinal approach with
optical magnification performed by a single-surgeon. Optical
magnification using frontal loops (3x) was utilized to spare the
spermatic artery and lymphatic ducts.

Outcome : The achievement of pregnancy and semen

parameters were recorded during postoperative period.
Postoperative semen analyses were obtained 6 months after
surgery.

Categorical data were examined by the chi-square test;

continuous variables were tested by t-test assuming p < 0.05 as
significant. The re-sults were elaborated using the statistical
program SigmaStat™for Windows®V2.03.
 RESULTS
 All 75 patients had 3rd grade left varicocele  Two patients were excluded
because of basal continuous reflux after surgery.
Age
• The patients’ mean age was 33.2 years (range 23-48 years)
• The mean age of the partners was 28.5 years (range 23-39 years).
Infertility
• The mean infertility period was 23 months (SD ±8.4, range 12-39 months).
History
• Tidak ada pasien yang melaporkan episode kriptorkismus, hidrokel, atau
trauma testis sebelumnya, dan juga tidak pernah menjalani operasi saluran
urogenital.
• No other causes of infertility were found.
Pregnancy preoperative
• Selama periode pra operasi 6-9 bulan sementara pasien berada dalam
daftar tunggu operasi, kehamilan dicapai dalam 1 pasangan (1,3%)
Follow up time
• The mean study follow-up time was 32.4 months (range 24-47 months)
DISCUSSION
 The main point of discussion is the clear benefit for
the rate of pregnancy when varicocele is treated in
infertile patients if other causes of male infertility,
as well as obvious causes of female infertility, are
ruled out.
 However, this point is debated by the scientific
literature because even prospective randomized
controlled trials of varicocele treatment in adults
have given conflicting results.
Strengths of the study :
• Metode jurnal mungkin lebih dekat dengan praktik klinis nyata
daripada uji klinis acak yang memiliki persentase penolakan
pengacakan yang lebih tinggi. Pasien yang sama adalah
kontrol mereka sendiri karena parameter mani dan tingkat
kehamilan diukur sebelum dan sesudah perawatan bedah
untuk varicocele pada populasi yang sama.
• Dilakukan dari tahun 2006-2011

Limitations of the study :

• We did not have a control group for comparison with our
treatment data.
• Our study was prospective but not randomized,and this is the
main limitation.
CONCLUSION

The surgical treatment of high

grade varicocele effectively:
-treats infertility,
-improving seminal
parameters and pregnancy
rate.
CRITICAL APPRAISAL
The structure and content of journal

 The title of the journal

 Positive
 Consist of variables studied : yes
 Bold : yes
 No abbreviation : yes
 The structure : >12 words (13)
 Negative
 -
 The author and institution
 Appropriate with the guidelines : yes
 ABSTRACT
 The structure
consist of 4 parts: purpose, materials and methods,
results, conclusion. There are key words
 Informative : yes
 Less than 250 words : no (276)
 INTRODUCTION
 Consist of two paragraph or part : 3 paragraphs
 The first paragraph explain background of the research :
yes
 The second paragraph explain hypothesis or objective : yes
 Less than one page : yes
METHOD
 Design of The Research

 Prospective study non randomized

 Inclusion and exclusion criteria: mentioned
 Study selection: mentioned
 Analytical studies: mentioned
 Outcome: mentioned
RESULT
 Characteristic of studies: included

 Accuracy of numeric data: trusted

 Accuracy and compatibility of analytic computer

program: trusted
 The result of analysis: included
Discussion

 The strengths & limitation: was written

 Comparison with other studies: included

Literature

 The structure: appropriate with guidelines

 Appropriate any citation: yes
 • Patient with high grade left
P varicocele

• Spermatic vein ligature through an

I inguinal approach with optical
magnification

C •-

• The achievement of pregnancy and

O semen parameters during postoperative
period
VALIDITY

Pertanyaan Jawaban
Apakah alokasi pasien pada penelitian ini dilakukan Tidak
secara acak?

Apakah pengamatan pasien dilakukan secara cukup Iya

panjang dan lengkap?

Apakah semua pasien dalam kelompok yang diacak, Tidak

dianalisis?

Apakah pasien dan dokter tetap blind dalam Tidak

melakukan intervensi, selain dari yang diuji?

Apakah kelompok perlakuan dan kontrol sama? Iya

APPLICABLE

Pertanyaan Jawaban
Apakah pada pasien kita terdapat perbedaan bila Tidak
dibandingkan dengan yang terdapat pada penelitian
sblmnya sehingga hasil tsb tdk dpt diterapkan pada
pasien kita?

Apakah penelitian tersebut mungkin dapat diterapkan Iya

pada pasien kita?

Apakah pasien memiliki potensi yang menguntungan Menguntungkan

atau merugikan bila penelitian tsb diterapkan?
 THANK YOU
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THANK YOU
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THANK YOU