Testicular vein syndrome and its treatment with a laparoscopic approach

Testicular vein syndrome (TVS) is a rare cause of ureteral obstruction. Only 5 previous cases are on record in the literature, and no review exists on this topic to date. Laparoscopic treatment has never been mentioned in the management of TVS.

We reviewed the literature related to this unusual entity to clarify the preoperative evaluation and the management of TVS. For this purpose, the data related to all the 5 cases previously reported so far in the English literature have been reviewed. Also, we report the sixth case of TVS, and the first patient to be successfully treated with the laparoscopic approach. This was a 37-year-old male with a 6-month history of left loin pain. Preoperative diagnosis was confirmed by CT-Urography.

Our patient underwent laparoscopic excision of the left testicular vein followed by ureteroureterostomy in a single sitting. The laparoscopic transperitoneal approach was used. Histopathological examination of the vein showed normal venous tissue. This is the sixth reported case of TVS and the first to be successfully treated with a laparoscopic technique.

A laparoscopic approach is safe and effective for treating patients with TVS with the common advantages of minimal invasiveness and better visualization of the complex anatomy of the retroperitoneum. Thus, it should be the treatment of choice for TVS.