1933 VARICOCELE SURGERY OR EMBOLIZATION: WHICH IS BETTER? IT DEPENDS ON WHOSE SIDE YOU ARE ON
Bibliographic record
Abstract
You have accessJournal of UrologyInfertility: Therapy/Evaluation1 Apr 20101933 VARICOCELE SURGERY OR EMBOLIZATION: WHICH IS BETTER? IT DEPENDS ON WHOSE SIDE YOU ARE ON Darby Cassidy, Dimitre Ranev, Cori Caughlin, Kirk Lo, Ethan Grober, Rob Beecroft, and Keith Jarvi Darby CassidyDarby Cassidy More articles by this author , Dimitre RanevDimitre Ranev More articles by this author , Cori CaughlinCori Caughlin More articles by this author , Kirk LoKirk Lo More articles by this author , Ethan GroberEthan Grober More articles by this author , Rob BeecroftRob Beecroft More articles by this author , and Keith JarviKeith Jarvi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1901AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A varicocele remains the most commonly identified correctable cause of male factor infertility. In North America, surgical correction is the most commonly performed technique to treat varicoceles with an expected technical failure rate of less than 5%. An alternative to surgery is selective catheterization and embolization of the gonadal vein using sclerosing agents, tissue adhesives, or detachable coils. The improvements in fertility following varicocele repair appear to be independent of the type of repair, as long as the repair was successful. Our objective was to the review the failure rates of varicocele embolization done for male factor infertility from our institution to determine if these rates were higher than expected with a surgical repair. METHODS Retrospective review of the University of Toronto varicocele database. All of the patients included in the database had clinical varicoceles with ultrasound confirmation. Patients with ultrasound evidence of a contralateral subclinical varicocele were offered bilateral varicocele embolization. RESULTS A total of 158 patients were identified from 2004 to 2008 who underwent embolization for clinical varicocele(s) and male factor infertility. 56% (88/158) underwent attempted bilateral embolization, 43% (68/158) unilateral left sided embolization, and 1.3% (2/158) unilateral right sided embolization. Of those patients who underwent attempted bilateral embolization, there was a 19.3% (17/88) technical failure rate in achieving successful obliteration of the right gonadal vein and a 2.3% (2/88) technical failure rate in the embolization of the left gonadal vein. Of the 2 attempts at unilateral right sided embolization there were no failures (0/2). Of 68 unilateral left sided embolization attempts there was a 4.4% failure rate (3/68). Of all of the right sided embolization attempts, 18.9% failed (17/90), while 3.2% (5/156) of the left sided attempts failed. CONCLUSIONS This review represents the largest contemporary series of varicocele embolization outcomes currently in the literature. Our 19.3% technical failure rate for bilateral varicocele embolization is higher than the current published rate of 13%. This was almost universally secondary to failure to access the right gonadal vein from the inferior vena cava. This supports our belief that bilateral varicoceles are best managed with a primary microsurgical approach where technical failure rates are expected to be less than 5% based on published data. Toronto, Canada© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e751 Peer Review Report Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Darby Cassidy More articles by this author Dimitre Ranev More articles by this author Cori Caughlin More articles by this author Kirk Lo More articles by this author Ethan Grober More articles by this author Rob Beecroft More articles by this author Keith Jarvi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.218 | 0.061 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".