Laparoscopic extravascular renal vein stent placement for nutcracker syndrome

To report our experience in the laparoscopic extravascular management of the nutcracker syndrome.

Three patients (two men and one woman) between the ages of 20 and 35 years (mean 25.7 y) underwent laparoscopic extravascular stent placement in the left renal vein for management of the nutcracker syndrome that is associated with severe recurrent gross hematuria and left gonadal vein varices. The postoperative follow-up was 16 to 37 months (mean 25.3 mos).

All patients met the criteria for establishing the diagnosis of the nutcracker syndrome. Ultrasonography, CT, and MRI revealed visible entrapment of the left renal vein between the superior mesenteric artery and aorta. Bleeding from the left ureteral orifice was detected by urethrocystoscopy and ureterorenoscopy. We attempted a novel laparoscopic method to manage this anatomic anomaly. No complications occurred during surgery. Total relief was achieved in two men without a relapse of symptoms, and abnormalities were not found in the results of the urine test. There is partial relief in a 20-year-old woman because of microhematuria after the operation.

The indications for surgical management with the nutcracker syndrome depend on the severity of the symptoms, and laparoscopic extravascular stent placement in the renal vein is a feasible approach for reestablishing free renal venous outflow. This slightly invasive treatment can eliminate the symptoms of the condition. Longer follow-up and more experience are necessary to make conclusions about its feasibility in contemporary practice, however.