The nutcracker phenomenon is defined as compression of the renal vein between the aorta and superior mesenteric artery and can present with loin pain, haematuria and a left-sided varicocele with treatment options including left renal vein transposition, superior mesenteric artery transposition, endovascular stenting of the left renal vein, nephropexy, and autotransplantation. This paper describes a novel method in 12 patients with the nutcracker phenomenon presenting as a left-sided aricocoele which entails a shunt using an anastomosis between the proximal part of the internal spermatic vein and inferior epigastric vein, thereby lowering the left renal vein pressure. In all patients, symptoms of haematuria, flank pain, proteinuria and scrotal discomfort disappeared. The diameter of the left renal vein and the peak velocity in the aortomesenteric portion of the left renal vein significantly decreased after surgery and left testicular volume significantly increased. The authors stress that this procedure not only treats the symptoms of the phenomenon but also reduces the potential for reduced fertility by improving left testicular function.

Surgical management of the nutcracker phenomenon presenting as a left varicocele in adolescents: a novel approach.
Dong W, Yao Y, Huan H, et el.
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Henrik Steinbrecher

Southampton University Hospital NHS Trust

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