[Varicocele and distal reflux].

The distal reflux as we call it raises several anatomical, operative technical and andrological questions. Based on our experiences with four patients with reduced seminal quality, we wish to make some contributions to this subject which has been only occasionally addressed in the past. In these patients, venous reflux could be demonstrated over the left funiculus spermaticus by means of Doppler sonography. The retrograde phlebography, carried out to sclerose transvenously the supposedly insufficient internal spermatic vein revealed, however, sufficient venous cuspids without reflux. The inguino-scrotal exploration of the funiculus, indicated to clarify further the distal venous testicular supply, showed the external spermatic and/or the deferential veins with their collaterals congested and dilated. All these vessels were ligated and divided. The demonstration and the topically correct treatment of the distal venous reflux seems to diminish, at least partially, the failure rate of the suprainguinal operation according to Bernardi. The correlation between the results of Doppler sonography, phlebography and the selection of the incision has not been clearly established yet. The different venous supplies of the testis are initially described.