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Updated: Feb 11, 2026
04:15
Combined Supine and Standing Imaging for Varicocele: An Improved Diagnostic Approach
Published on: November 22, 2024
737
[Microsurgical bypass for varicocele with nutcracker syndrome]
Guo-Xiao Chen1, Xiang-Sheng Zhang1, Xiao-Bo Zhu1
1Department of Urology, Henan Provincial People's Hospital / People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, China.
Summary
Internal spermatic vein-inferior epigastric vein (ISV-IEV) bypass surgery effectively treats varicocele with left renal vein nutcracker syndrome (NCS). The procedure offers significant improvements in sperm parameters and resolution of related symptoms.
Area of Science:
- Vascular Surgery
- Urology
- Andrology
Background:
- Varicocele and left renal vein nutcracker syndrome (NCS) can coexist, impacting male fertility and causing symptoms like hematuria.
- Current treatment options may have limitations.
Purpose of the Study:
- To evaluate the clinical efficacy and feasibility of internal spermatic vein-inferior epigastric vein (ISV-IEV) bypass surgery.
- To assess outcomes in patients with varicocele complicated by left renal vein NCS.
Main Methods:
- Retrospective analysis of 30 patients with varicocele and left renal vein NCS.
- ISV-IEV bypass surgery performed between June 2014 and February 2017.
- Follow-up included ultrasonography, urinalysis, and semen analysis.
Main Results:
- All surgeries were successful, with complete varicocele cure confirmed by Doppler ultrasonography.
- Significant improvements observed in sperm concentration and motility (grade a+b) at 6 months post-surgery.
- High rates of hematuria resolution (23/24 cases) and complete proteinuria disappearance (14/14 cases).
Conclusions:
- ISV-IEV bypass surgery is a safe and effective treatment for varicocele with left renal vein NCS.
- The procedure demonstrates minimal invasiveness and simplicity, supporting its clinical adoption.
- This surgical approach offers a promising solution for patients with this complex condition.
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