title: Antegrade venography identifies parallel venous duplications in the majority of adolescents with varicocele.
abstract: OBJECTIVE
  We performed intraoperative antegrade venography to assess the prevalence of internal spermatic venous malformations in adolescents with varicocele.
  
  
  METHODS
  During a 2-year period 58 adolescent males with visible or palpable varicocele underwent antegrade venography before varicocele surgery. Antegrade venography was performed through a scrotal incision. A vein within the pampiniform plexus was cannulated and up to 1.75 mg/kg iohexol 300 mg/ml was injected to outline the entire length of the internal spermatic vein. The radiographs were reviewed and classified according to Bähren and Murray criteria.
  
  
  RESULTS
  Of the patients 43 (74.1%) demonstrated parallel duplications (Murray classification type P) of the internal spermatic vein. This rate is higher than the 2% reported based on retrograde venography. Of the patients with parallel duplications 21 (48.8%) showed duplications arising superior to the iliac crest (subtype A) and 22 (51.2%) had a combination of proximal duplications (subtypes B and C). Ten patients (17.2%) had a single internal spermatic vein, 2 (3.4%) had lumbar collaterals and 3 (5.2%) had renal collaterals.
  
  
  CONCLUSIONS
  Parallel duplication of the internal spermatic vein is a common finding on antegrade venography. The various levels of duplication need to be identified before treatment of varicocele to maximize the success of the procedure.
authors: Department of Pediatric Urology and Department of Pediatric Radiology (AS), Royal Manchester Children's Hospital, Manchester, United Kingdom.
authors: Poongkodi
authors: P
authors: Nagappan
authors: Department of Pediatric Urology and Department of Pediatric Radiology (AS), Royal Manchester Children's Hospital, Manchester, United Kingdom.
authors: David
authors: D
authors: Keene
authors: Department of Pediatric Urology and Department of Pediatric Radiology (AS), Royal Manchester Children's Hospital, Manchester, United Kingdom.
authors: Francesco
authors: F
authors: Ferrara
authors: Department of Pediatric Urology and Department of Pediatric Radiology (AS), Royal Manchester Children's Hospital, Manchester, United Kingdom.
authors: Abdusamea
authors: A
authors: Shabani
authors: Department of Pediatric Urology and Department of Pediatric Radiology (AS), Royal Manchester Children's Hospital, Manchester, United Kingdom. Electronic address: raimondo.cervellione@cmft.nhs.uk.
authors: Raimondo M
authors: RM
authors: Cervellione
mesh_terms: D000293:Adolescent; D006801:Humans; D008297:Male; D010690:Phlebography / Q000379:methods; D011446:Prospective Studies; D013085:Spermatic Cord / Q000098:blood supply*; D013737:Testis / Q000098:blood supply*; D014646:Varicocele / Q000000981:diagnostic imaging*; D014680:Veins / Q000002:abnormalities
keywords: anatomy; phlebography; recurrence; varicocele