Nephron-sparing surgery has become the standard of care for renal masses that are < 4 cm in size. A renal artery pseudoaneurysm (RAP) following nephron-sparing surgery is a rare but well-documented complication. The most common presenting symptom is hematuria, but bleeding is not universal and differential diagnosis is essential to successful treatment. A high index of suspicion and proper imaging tests aid diagnosis. The present 34-year-old male demonstrates an unusual presentation of RAP following nephron-sparing surgery with no evidence of hematuria. In recent years, percutaneous selective arterial embolization has emerged as a simple and effective modality for managing RAPs in hemodynamically stable patients.

Kapil Singla, Sistla B Viswaroop, Myilswamy Arul, Ganesh Gopalakrishnan, Sangam V Kandasami

Department of Urology, Vedanayagam Hospital and Postgraduate Institute, Coimbatore, India

Submitted November 6, 2010 - Accepted for Publication November 21, 2010

KEYWORDS: Pseudoaneurysm; Angioembolization; Partial nephrectomy.

CORRESPONDENCE: Dr. Ganesh Gopalakrishnan, Consultant Urologist, Vedanayagam Hospital, R S Puram, Coimbatore, India ().

CITATION: UroToday Int J. 2011 Feb;4(1):art1. doi:10.3834/uij.1944-5784.2011.02.01

ABBREVIATIONS AND ACRONYMS: CT, computed tomography; RAP, renal artery pseudoaneurysm.

INTRODUCTION: The purpose of this prospective investigation was to study the impact of inguinal varicocele ligation on testicular volume, sperm parameters, and pregnancy rates before and after varicocelectomy.

METHODS: Participants were an experimental group of 50 infertile men with a mean age of 29.6 years (range, 23-36 years) and a comparison group of 50 age-matched, healthy fertile men. All infertile men had a clinical left grade 2 or grade 3 varicocele. Each participant received the same baseline tests of clinical examination, semen analysis, and scrotal ultrasonography. Tests were repeated 3 and 6 months after inguinal varicocele repair for patients in the experimental group. Outcome measures were semen parameters, testicular volumes, percentage of volume difference between the right and left testicles, and pregnancy rates. The t test was used to compare the baseline measures of the 2 groups. A Freidman repeated measures analysis of variance was performed to compare the results of the experimental group at baseline and at 3 months and 6 months after surgery. Comparison group baseline data were also compared with the experimental group data at 6 months.

RESULTS: Participants in the experimental group had significantly lower baseline mean sperm concentration and sperm motility and higher mean testicular volume differences than the participants in the comparison group (all with P < .0001); there was no significant group difference in baseline mean semen volume. Varicocele ligation resulted in significantly increased mean sperm concentration and motility and significantly decreased mean testicular volumes 3 months and 6 months after surgery (all with P < .0001). There was no significant change in semen volume. Sperm concentration and sperm motility reached near-normal levels following surgery, but patients continued to have significantly larger mean testicular volume differences than those of the comparison group. Mean right and left testicular volume difference was significantly correlated with mean sperm motility 6 months postoperatively (Pearson r = -0.365; P = .009), but not significantly correlated with sperm concentration or semen volume. The partners of 24 patients (48%) were pregnant 6 months postoperatively.

CONCLUSION: Varicocele ligation improves ipsilateral testicular volume loss, semen profile, and pregnancy rates.

Mostafa A Mohamed, Mohamed G ElShiekh, Hany M ElFayoumy, Amr S Fayad, Ibrahim F Hussein, AbdelRahim E Hegazy

Department of Urology, Kasr AlAini Hospital, Cairo University, Cairo, Egypt

Submitted September 28, 2010 - Accepted for Publication November 19, 2010

KEYWORDS: Varicocele; Pregnancy rates; Semen parameters; Testicular volume.

CORRESPONDENCE: Dr. Hany M. ElFayoumy, MD, MRCS, FEBU, Lecturer of Urology, Kasr Al-Aini Hospitals, Cairo University, Egypt ().

CITATION: Urotoday Int J. 2011 Feb;4(1):art2. doi:10.3834/uij.1944-5784.2011.02.02

ABBREVIATIONS AND ACRONYMS: TV, testicular volume; WHO, World Health Organization.