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

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 < 0.001). Left testicular volume significantly increased after surgery. One patient had recurrence of the left varicocele and one adolescent had minimal hydrocele requiring no intervention. No major complications were observed during and after surgery.

Conclusion: Anastomosis of the proximal part of the spermatic vein and inferior epigastric vein is an efficacious and safe surgical approach for the management of nutcracker phenomenon presenting as left varicocele in adolescents.

Keywords: Adolescent; Nutcracker phenomenon; Shunt operation; Varicocele.