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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
  • 47 Downloads

Abstract

Objectives

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

Methods

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.

Results

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.

Conclusion

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

Keywords

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

Notes

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.

Funding

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.

References

  1. 1.
    Gulleroglu K, Gulleroglu B, Baskin E (2014) Nutcracker syndrome. World J Nephrol 3:277–281CrossRefGoogle Scholar
  2. 2.
    Alaygut D, Bayram M, Soylu A et al (2013) Clinical course of children with nutcracker syndrome. Urology 82:686–690CrossRefGoogle Scholar
  3. 3.
    Kurklinsky AK, Rooke TW (2010) Nutcracker phenomenon and nutcracker syndrome. Mayo Clin Proc 85:552–559CrossRefGoogle Scholar
  4. 4.
    Del Canto Peruyera P, Vaquero Lorenzo F, Vallina-Victorero Vazquez MJ et al (2014) Recurrent hematuria caused by nutcracker syndrome. Ann Vasc Surg 28(1036):e15–19Google Scholar
  5. 5.
    Vianello FA, Mazzoni MB, Peeter GG et al (2016) Micro- and macroscopic hematuria caused by renal vein entrapment: systematic review of the literature. Pediatr Nephrol 31:175–184CrossRefGoogle Scholar
  6. 6.
    Takebayashi S, Ueki T, Ikeda N et al (1999) Diagnosis of the nutcracker syndrome with color Doppler sonography: correlation with flow patterns on retrograde left renal venography. AJR Am J Roentgenol 172:39–43CrossRefGoogle Scholar
  7. 7.
    Takahashi Y, Ohta S, Sano A et al (2000) Does severe nutcracker phenomenon cause pediatric chronic fatigue? Clin Nephrol 53:174–181PubMedGoogle Scholar
  8. 8.
    Wendel RG, Crawford ED, Hehman KN (1980) The “nutcracker” phenomenon: an unusual cause for renal varicosities with hematuria. J Urol 123:761–763CrossRefGoogle Scholar
  9. 9.
    Hohenfellner M, D’Elia G, Hampel C et al (2002) Transposition of the left renal vein for treatment of the nutcracker phenomenon: long term follow-up. Urology 59:354–357CrossRefGoogle Scholar
  10. 10.
    Chuang CK, Chu SH, Lai PC (1997) The nutcracker syndrome managed by autotransplantation. J Urol 157:1833–1834CrossRefGoogle Scholar
  11. 11.
    Liu Y, Sun Y, Jin X (2012) Left renocaval venous bypass with autologous great saphenous vein for nutcracker syndrome. J Vasc Surg 55:1482–1484CrossRefGoogle Scholar
  12. 12.
    Zhang Q, Zhang Y, Lou S et al (2010) Laparoscopic extravascular renal vein stent placement for nutcracker syndrome. J Endourol 24:1631–1635CrossRefGoogle Scholar
  13. 13.
    Liu Y, Sun Y, Wu XJ et al (2012) Endovascular stent placement for the treatment of nutcracker syndrome. Int Urol Nephrol 44(4):1097–1100CrossRefGoogle Scholar
  14. 14.
    Pallwein L, Pinggera G, Schuster AH et al (2004) The influence of left renal vein entrapment on outcome after surgical varicocele repair a color Doppler sonographic demonstration. J Ultrasound Med 23:595–601CrossRefGoogle Scholar
  15. 15.
    Li H, Zhang M, Jiang Y et al (2014) Microsurgical spermatic-inferior epigastric vein anastomosis for treating nutcracker syndrome-associated varicocele in infertile men: a preliminary experience. Urology 83:94–99CrossRefGoogle Scholar
  16. 16.
    Kim SH, Cho SW, Kim HD et al (1996) Nutcracker syndrome: diagnosis with Doppler US. Radiology 198:93–97CrossRefGoogle Scholar
  17. 17.
    Vander Brink BA, Palmer LS, Gitlin J et al (2007) Lymphatic-sparing laparoscopic varicocelectomy versus microscopic varicocelectomy: is there a difference? Urology 70:1207–1210CrossRefGoogle Scholar
  18. 18.
    Karazincir S, Balci A, Görür S et al (2007) Incidence of the retroaortic left renal vein in patients with varicocele. J Ultrasound Med 26:601–604CrossRefGoogle Scholar
  19. 19.
    Wang L, Yi L, Yang L et al (2009) Diagnosis and surgical treatment of nutcracker syndrome: a single-center experience. Urology. 73:871–876CrossRefGoogle Scholar
  20. 20.
    Kaan G, Basak G, Esra B (2014) Nutcracker syndrome. J World J Nephrol 6:277–281Google Scholar
  21. 21.
    Zhang Q, Zhang Y, Lou S et al (2010) Laparoscopic extravascular stent renal vein placement for nutcracker syndrome. J Endourol 24:1631–1635CrossRefGoogle Scholar
  22. 22.
    Guzel O, Aslan Y, Balci M et al (2015) Significant worsening sperm parameters are associated to testicular hypotrophy in patients with a high grade varicocele. Actas Urol Esp 39:392–395CrossRefGoogle Scholar
  23. 23.
    MacLachlan LS, Nees SN, Fast AM et al (2013) Intratesticular varicoceles: are they significant? J Pediatr Urol 9:851–855CrossRefGoogle Scholar
  24. 24.
    Thomas JC, Elder JS (2002) Testicular growth arrest and adolescent varicocele: does varicocele size make a difference? J Urol 168:1689–1691CrossRefGoogle Scholar
  25. 25.
    Koshimichi M, Sugimoto K, Yanagida H et al (2012) Newly-identified symptoms of left renal vein entrapment syndrome mimicking orthostatic disturbance. World J Pediatr 8:116–122CrossRefGoogle Scholar
  26. 26.
    López-Monjardin H, de la Peña-Salcedo JA (2000) Techniques for management of size discrepancies in microvascular anastomosis. Microsurgery 20:162–166CrossRefGoogle Scholar
  27. 27.
    Cakir B, Akan M, Aköz T (2003) The management of size discrepancies in microvascular anastomoses. Acta Orthop Traumatol Turc 37:379–385PubMedGoogle Scholar
  28. 28.
    Diegidio P, Jhaveri JK, Ghannam S et al (2011) Review of current varicocelectomy techniques and their outcomes. BJU Int 108:1157–1172CrossRefGoogle Scholar

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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