International Urology and Nephrology

, Volume 51, Issue 11, pp 1925–1932 | Cite as

Ultrasound-assisted microsurgical left spermatic-inferior epigastric vein anastomosis for treating nutcracker syndrome-associated varicocele

  • Jianwei Hao
  • Honglin ShiEmail author
  • Hao Xu
  • Jiping Zhu
  • Jun Zhou
  • Tao DuEmail author
Urology - Original Paper



The study summarizes the effectiveness of ultrasound-assisted microsurgical left spermatic-inferior epigastric vein anastomosis for treating nutcracker syndrome (NCS)-associated varicocele.


Cases of NCS-associated varicocele were recruited between December 2012 and December 2018. Prior to the operation, all patients were tested for the internal diameter and blood flow velocity of left renal vein, testicular volume, maximum venous diameter and venous retrograde flow in the pampiniform plexus of veins during the Valsalva maneuver by Color Doppler ultrasound. Moreover, the direction of left spermatic and inferior epigastric vein was marked.


All patients underwent ligation of the internal spermatic veins and left spermatic-inferior epigastric vein anastomosis under microscopy. Color Doppler ultrasound, urinary and semen analysis (above age 18 years old) were reviewed during the follow-up period. 53 patients (94.6%) underwent spermatic-inferior epigastric vein anastomosis with the mean operation time of 78.4 ± 14.2 min. The hospital stay was 4–7 days. Scrotal hydrocele, wound infection and testicular atrophy did not occur after operation. However, there were 5 cases of left varicocele recurrence and 2 cases of vascular anastomotic thrombosis. 51 cases had decrease in blood peak flow rate of left renal vein and improvement in nutcracker syndrome while scrotal bulge symptoms resolved in 26 cases. 10 cases had microscopic hematuria disappearance with symptom improvement in 2 cases. 19 cases of left testicular hypotrophy experience no further deterioration after surgery, of which 16 cases had catch-up testicular growth.


Ultrasound-assisted microsurgical left spermatic-inferior epigastric vein anastomosis assisted is safe, easy and effective for treating nutcracker syndrome-associated varicocele.


Left spermatic-inferior epigastric vein anastomosis Microsurgical Nutcracker syndrome Varicocele Color Doppler ultrasonography 


Author contributions

TD and HS had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: TD, HS. Analysis and interpretation of data: HX, JZ, JZ. Drafting of the manuscript: JH, Tao Du Critical revision of the manuscript for important intellectual content: Supervision: TD, HS. Other: None. All authors have read and approved the final version of the manuscript, and agree with the order of presentation of the authors.


This study was financially supported by Scientific and Technological Project of Henan Province (162102310172).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of UrologyHenan Provincial People’s HospitalZhengzhouPeople’s Republic of China
  2. 2.Department of UrologyPeople’s Hospital of Henan UniversityZhengzhouPeople’s Republic of China
  3. 3.Department of UrologyPeople’s Hospital of Zhengzhou UniversityZhengzhouPeople’s Republic of China

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