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Updated: Jun 11, 2025
04:15
Combined Supine and Standing Imaging for Varicocele: An Improved Diagnostic Approach
Published on: November 22, 2024
124
Renal nutcracker syndrome presenting with varicocele: A case series
Hesam Mosavari1, Milad Sarafi1, Ali Hosseininasab1
1Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
International Journal of Surgery Case Reports
|October 1, 2024
Summary
Nutcracker syndrome (NCS) can present with varicocele and pain, even without hematuria. Surgical intervention effectively resolved symptoms in adolescent males, highlighting a need for revised diagnostic approaches.
Area of Science:
- Urology
- Vascular Surgery
- Diagnostic Imaging
Background:
- Nutcracker syndrome (NCS) involves left renal vein compression, presenting with varied symptoms.
- Varicocele is a common condition in adolescent males, often associated with pain.
Purpose of the Study:
- To evaluate clinical presentations and outcomes of patients with NCS and varicocele.
- To highlight diagnostic challenges in NCS, particularly the absence of hematuria.
Main Methods:
- Retrospective case series of four male patients (15-19 years) with recurrent varicocele.
- Diagnosis of NCS confirmed via duplex ultrasound and contrast-enhanced CT scans.
- Surgical interventions included gonadal vein transposition or saphenous vein bypass.
Main Results:
- All patients experienced hypogastric, flank, or groin pain.
- NCS diagnosis was made despite the absence of hematuria.
- Surgical interventions successfully resolved symptoms; one varicocele resolved post-NCS surgery, and three had successful varicocelectomies.
Conclusions:
- NCS can present with varicocele and pain without hematuria, challenging current diagnostic criteria.
- Consider NCS in patients with varicocele and pain, even without hematuria.
- Surgical management is effective for NCS presenting with varicocele.
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