Surgical management of nutcracker phenomenon presenting as left varicocele in adolescents: A novel approach

• Published in: Journal of pediatric urology 2014-06, Vol.10 (3), p.424-429
• Main Authors: Dong, Wen, Yao, Yousheng, Huang, Hai, Han, Jinli, Zhao, Xinbao, Huang, Jian
• Format: Article
• Language: English
• Subjects: Adolescent; Anastomosis, Surgical - methods; Child; Diagnosis, Differential; Follow-Up Studies; Humans; Male; Nutcracker phenomenon; Pediatrics; Renal Nutcracker Syndrome - complications; Renal Nutcracker Syndrome - diagnosis; Renal Nutcracker Syndrome - surgery; Renal Veins - diagnostic imaging; Renal Veins - surgery; Retrospective Studies; Shunt operation; Spermatic Cord - blood supply; Spermatic Cord - diagnostic imaging; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography; Urologic Surgical Procedures, Male - methods; Urology; Varicocele; Varicocele - diagnosis; Varicocele - etiology; Varicocele - surgery; Veins - surgery
• ISSN: 1477-5131; 1873-4898
• DOI: 10.1016/j.jpurol.2013.09.019

Abstract Objective To present a new approach using a shunt operation for the management of nutcracker phenomenon presenting as left varicocele in adolescent patients. Materials and methods 12 adolescent patients with the nutcracker phenomenon presenting as left varicocele underwent a shunt operation consisting of anastomosis of the proximal part of the spermatic vein and inferior epigastric vein to lower the left renal vein (LRV) pressure. A simple ligation of the left spermatic vein was then used to repair the varicocele. Results 12 patients underwent surgery, and symptoms of hematuria, proteinuria, scrotum discomfort, and flank pain disappeared post surgery in all patients. Patients were followed for 24–72 months (mean 48 months). The diameters of the proximal LRV and the peak velocities in the aortomesenteric portion of the LRV were significantly decreased after surgery ( p