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Microsurgical gonadal-inferior epigastric vein anastomosis to treat the nutcracker phenomenon with left gonadal vein varices with reflux

  • Urology - Original Paper
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Abstract

Objective

To evaluate the effectiveness and safety of microsurgical gonadal-inferior epigastric vein anastomosis for the treatment of the nutcracker phenomenon (NCP) associated with left gonadal vein varices with reflux.

Methods

Thirty-five patients with NCP associated with left gonadal vein varices with reflux diagnosed in our hospital from June 2016 to June 2018 were included. All patients underwent a shunt operation consisting of microsurgical gonadal-inferior epigastric vein anastomosis, and the patients were followed up for 1 year.

Results

All patients were successfully operated on, with an average operation time of 96.5 ± 12.3 min. After a 1-year follow-up, the symptom of gross hematuria disappeared in 3 patients (including 1 woman). For the other 32 patients, the sperm concentration (27.43 ± 8.68 × 106/ml) and motility (33.06 ± 4.27%) postoperatively were significantly higher than that preoperatively (16.21 ± 6.43 × 106/ml and 23.48 ± 4.43%, respectively) (P < 0.05); among these patients, 2 had natural pregnancies with their spouses. The peak velocity (PV) at the aortomesenteric portion of the left renal vein (LRV) and the PV ratio between the aortomesenteric and hilar portion of the LRV significantly decreased after surgery (117.9 ± 30.4 cm/s vs 76.6 ± 18.5 cm/s; 7.3 ± 0.7 vs 4.1 ± 0.4). Two patients had complications of mild hydroceles requiring no intervention, and no major complications were observed during and after surgery.

Conclusion

Our results suggest that the microsurgical gonadal-inferior epigastric vein anastomosis is both effective and safe to treat patients with gonadal varicose veins caused by the nutcracker phenomenon.

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References

  1. de Schepper A (1972) “Nutcracker” phenomenon of the renal vein and venous pathology of the left kidney. J Belge Radiol 55(5):507–511

    PubMed  Google Scholar 

  2. Shin JI, Lee JS, Kim MJ (2006) The prevalence, physical characteristics and diagnosis of nutcracker syndrome. Eur J Vasc Endovasc Surg 32(3):335–336

    Article  CAS  Google Scholar 

  3. Ananthan K, Onida S, Davies AH (2017) Nutcracker syndrome: an update on current diagnostic criteria and management guidelines. Eur J Vasc Endovasc Surg 53(6):886–894

    Article  CAS  Google Scholar 

  4. Nishimura Y, Fushiki M, Yoshida M, Nakamura K, Imai M, Ono T, Morikawa S, Hatayama T, Komatz Y (1986) Left renal vein hypertension in patients with left renal bleeding of unknown origin. Radiology 160(3):663–667

    Article  CAS  Google Scholar 

  5. Wei SM, Chen ZD, Zhou M (2003) Intravenous stent placement for treatment of the nutcracker syndrome. J Urol 170(5):1934–1935

    Article  Google Scholar 

  6. Ekim M, Bakkaloglu SA, Tumer N, Sanlidilek U, Salih M (1999) Orthostatic proteinuria as a result of venous compression (nutcracker phenomenon)–a hypothesis testable with modern imaging techniques. Nephrol Dial Transplant 14(4):826–827

    Article  CAS  Google Scholar 

  7. Shin JI, Park JM, Lee JS, Kim MJ (2007) Effect of renal Doppler ultrasound on the detection of nutcracker syndrome in children with hematuria. Eur J Pediatr 166(5):399–404

    Article  Google Scholar 

  8. Okada M, Tsuzuki K, Ito S (1998) Diagnosis of the nutcracker phenomenon using two-dimensional ultrasonography. Clin Nephrol 49(1):35–40

    CAS  PubMed  Google Scholar 

  9. Takebayashi S, Ueki T, Ikeda N, Fujikawa A (1999) Diagnosis of the nutcracker syndrome with color Doppler sonography: correlation with flow patterns on retrograde left renal venography. AJR Am J Roentgenol 172(1):39–43

    Article  CAS  Google Scholar 

  10. Li H, Zhang M, Jiang Y, Zhang Z, Na W (2014) Microsurgical spermatic-inferior epigastric vein anastomosis for treating nutcracker syndrome-associated varicocele in infertile men: a preliminary experience. Urology 83(1):94–99

    Article  Google Scholar 

  11. Kim SH (2019) Doppler US and CT diagnosis of nutcracker syndrome. Korean J Radiol 20(12):1627–1637

    Article  Google Scholar 

  12. Organization WH (2010) WHO Laboratory Manual for the Examination and Processing of Human Semen. 5th edn. WHO

  13. Hao J, Shi H, Xu H, Zhu J, Zhou J, Du T (2019) Ultrasound-assisted microsurgical left spermatic-inferior epigastric vein anastomosis for treating nutcracker syndrome-associated varicocele. Int Urol Nephrol 51(11):1925–1932

    Article  CAS  Google Scholar 

  14. Ahmed K, Sampath R, Khan MS (2006) Current trends in the diagnosis and management of renal nutcracker syndrome: a review. Eur J Vasc Endovasc Surg 31(4):410–416

    Article  CAS  Google Scholar 

  15. He Y, Wu Z, Chen S, Tian L, Li D, Li M, Jin W, Zhang H (2014) Nutcracker syndrome–how well do we know it? Urology 83(1):12–17

    Article  Google Scholar 

  16. Kurklinsky AK, Rooke TW (2010) Nutcracker phenomenon and nutcracker syndrome. Mayo Clin Proc 85(6):552–559

    Article  Google Scholar 

  17. Wang L, Yi L, Yang L, Liu Z, Rao J, Liu L, Yang J (2009) Diagnosis and surgical treatment of nutcracker syndrome: a single-center experience. Urology 73(4):871–876

    Article  Google Scholar 

  18. Chuang CK, Chu SH, Lai PC (1997) The nutcracker syndrome managed by autotransplantation. J Urol 157(5):1833–1834

    Article  CAS  Google Scholar 

  19. Venkatachalam S, Bumpus K, Kapadia SR, Gray B, Lyden S, Shishehbor MH (2011) The nutcracker syndrome. Ann Vasc Surg 25(8):1154–1164

    Article  Google Scholar 

  20. Hohenfellner M, D'Elia G, Hampel C, Dahms S, Thuroff JW (2002) Transposition of the left renal vein for treatment of the nutcracker phenomenon: long-term follow-up. Urology 59(3):354–357

    Article  Google Scholar 

  21. Kawa G, Kawakita S, Fujita I, Matsuda T (2000) A simple treatment for gross haematuria caused by the 'nutcracker' phenomenon. BJU Int 86(7):908–909

    Article  CAS  Google Scholar 

  22. Dong W, Yao Y, Huang H, Han J, Zhao X, Huang J (2014) Surgical management of nutcracker phenomenon presenting as left varicocele in adolescents: a novel approach. J Pediatr Urol 10(3):424–429

    Article  Google Scholar 

  23. Chen G-X, Zhang X-S, Zhu X-B, Chen X (2017) Microsurgical bypass for varicocele with nutcracker syndrome. Zhonghua Nan Ke Xue 23(9):798–803

    PubMed  Google Scholar 

  24. Durham JD, Machan L (2013) Pelvic congestion syndrome. Semin Intervent Radiol 30(4):372–380

    Article  Google Scholar 

  25. Scultetus AH, Villavicencio JL, Gillespie DL (2001) The nutcracker syndrome: its role in the pelvic venous disorders. J Vasc Surg 34(5):812–819

    Article  CAS  Google Scholar 

  26. d'Archambeau O, Maes M, De Schepper AM (2004) The pelvic congestion syndrome: role of the “nutcracker phenomenon” and results of endovascular treatment. JBR-BTR : organe de la Societe royale belge de radiologie (SRBR) = orgaan van de Koninklijke Belgische Vereniging voor Radiologie (KBVR) 87 (1):1–8

  27. Jeanneret C, Beier K, von Weymarn A, Traber J (2016) Pelvic congestion syndrome and left renal compression syndrome - clinical features and therapeutic approaches. VASA Zeitschrift fur Gefasskrankheiten 45(4):275–282

    Article  Google Scholar 

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Author notes

  1. Yu-tao Li and Qi Yang two authors contributed equally to this work.

Authors and Affiliations

  1. Assisted Reproduction Center of Eastern Hospital, Sichuan Academy of Medical Science and Sichuan Provincial People’s Hospital, Chengdu, 610041, Sichuan, China

    Yu-tao Li, Jun-cheng Yao & Qun Lv

  2. Urology of Eastern Hospital, Sichuan Academy of Medical Science and Sichuan Provincial People’s Hospital, ChengduSichuan, 610041, China

    Qi Yang

  3. Department of Urology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China

    Si-qiao Liu & Ke Dou

Authors
  1. Yu-tao Li
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  2. Qi Yang
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  3. Jun-cheng Yao
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  4. Qun Lv
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  5. Si-qiao Liu
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  6. Ke Dou
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YTL and QY collected, analyzed, interpreted the data, and wrote the manuscript. All authors read and approved the final manuscript.

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Correspondence to Ke Dou.

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Li, Yt., Yang, Q., Yao, Jc. et al. Microsurgical gonadal-inferior epigastric vein anastomosis to treat the nutcracker phenomenon with left gonadal vein varices with reflux. Int Urol Nephrol 52, 1629–1635 (2020). https://doi.org/10.1007/s11255-020-02478-y

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  • DOI: https://doi.org/10.1007/s11255-020-02478-y

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