Case Report; Concomitant Left Nutcracker Syndrome and Right Ureteropelvic Junction Obstruction

Area of Science:

• Urology
• Nephrology
• Vascular Medicine

Background:

• Nutcracker syndrome (NCS) involves renal vein compression, often presenting with flank pain.
• Ureteropelvic junction obstruction (UPJO) obstructs urine flow from the kidney, causing flank pain.
• Concomitant occurrence of NCS and UPJO is exceptionally rare.

Observation:

• An adult female presented with intermittent bilateral flank pain.
• CT urogram revealed concurrent left nutcracker syndrome and right ureteropelvic junction obstruction.
• The patient experienced bothersome symptoms primarily from the UPJO.

Findings:

• Anderson-Hynes pyeloplasty was performed for the right UPJO, initially laparoscopic but converted to open surgery due to stenting difficulties.
• The patient experienced a smooth postoperative recovery and was discharged on the third postoperative day.
• Symptoms related to nutcracker syndrome were mild and did not necessitate immediate intervention.

Implications:

• This case underscores the importance of comprehensive diagnostic evaluation for complex urological presentations.
• Conservative management may be appropriate for symptomatic nutcracker syndrome when less severe than other concurrent pathologies.
• Surgical intervention for UPJO can be successful even with conversion from laparoscopic to open procedures.
• Further research into the combined pathophysiology and management of these rare co-occurring conditions is warranted.