Di-san junyi daxue xuebao (Jun 2021)

Efficacy of microscopic spermatic vein ligation in treatment of nutcracker syndrome with only left varicocele

  • CHEN Yanlin,
  • LIANG Peihe,
  • ZHOU Zhihao

Journal volume & issue
Vol. 43, no. 12
pp. 1162 – 1166


Read online

Objective To evaluate the efficacy and safety of microscopic ligation of spermatic vein in the treatment of nutcracker syndrome (NCS) with only left spermatic vein (LSV) varicocele. Methods The clinical data of 34 patients with moderate and severe LSV varicocele caused by NCS who were admitted to our hospital from February 2016 to November 2020 were retrospectively analyzed, and the preoperative and postoperative clinical symptoms and examination results of the patients were evaluated and compared. Results Low-position ligation of LSV under microscope was successfully performed in all 34 cases. Of the 19 patients with preoperative discomfort and pain of swollen testicle, 17 were significantly relieved after the surgery. No complications such as testicular hydrocele and scrotal edema occurred in all the patients, and during the follow-up of 3-15 months, no recurrence was found. Among the patients, the left spermatic vein diameter (LSVD), sperm density, forward motility sperm count, total testosterone and follicle-stimulating hormone (FSH) were significantly improved 3 months after the surgery (P 0.05) in sperm motility, luteinizing hormone (LH) and following ultrasonographic indicators: velocity of the left renal vein (LRV) at the angle between the abdominal aorta (AO) and the superior mesenteric artery (SMA) (PV1), velocity of the LRV near the renal hilum (PV2), PV1/PV2; inner diameter of the LRV at the angle between the AO and SMA (LRVD1), inner diameter of the LRV near the renal hilum (LRVD2), and LRVD1/LRVD2. Conclusion Microsurgical ligation of LSV is safe and effective in the treatment of moderate and severe left varicocele caused by NCS, which can significantly improve the clinical symptoms and semen quality, without aggravating the nutcracker phenomenon or causing other clinical manifestations of NCS.