Left spermatic vein transposition to great saphenous vein：preliminary experience of a novel bypass procedure in 8 patients in the treatment of left varicocele secondary to nutcracker syndrome
10.3969/j.issn.1009-8291.2025.04.012
- VernacularTitle:精索内静脉-大隐静脉分流术治疗胡桃夹综合征继发左侧精索静脉曲张：8例初步探索
- Author:
Guoxiong LUO
1
;
Fudong LI
1
;
Chang YU
1
;
Zhigang CAO
1
;
Chunlei ZHANG
1
;
Bin ZHANG
1
;
Dehui CHANG
1
Author Information
1. Department of Urology, The 940th Hospital of PLA Joint Logistics Support Forces, Lanzhou 730050, China
- Publication Type:Journal Article
- Keywords:
nutcracker syndrome;
bypass;
varicocele;
great saphenous vein
- From:
Journal of Modern Urology
2025;30(4):333-338
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To evaluate the efficacy of the left spermatic vein transposition to the great saphenous vein in treating left varicocele (VC) secondary to nutcracker syndrome (NCS). Methods: Clinical data of 8 patients treated during Feb.2020 and Feb.2023 in our hospital were retrospectively analyzed.A meticulous preoperative evaluation of the vascular status of the spermatic vein and the great saphenous vein was performed using color Doppler ultrasound.A spermatic vein-great saphenous vein shunt surgery was performed in patients who were strictly selected.The clinical symptoms and hemodynamics of renal vein were compared before and after operation. Results: The median age of patients was 23.5(18-33) years.There was a notable reduction in post-exercise scrotal and lower back pain in all patients，and the score of scrotal pain decreased to 0 in 7 patients. The median quantification of urinary protein was 352.8(54.4-687.3) mg prior to surgical intervention，which significantly diminished to 125.5(25.9-255.1) mg 6 months after operation.Notably，3 cases of preoperative positive urine occult blood tests were undetectable in the subsequent postoperative assessments.The median peak blood flow velocity at the site of stenosis in the left renal vein measured at 74.4(48.7-117.6) cm/s preoperatively，subsequently reduced to 45.1(25.5-61.2) cm/s postoperatively.During the 6-month follow-up，no recurrence of varicocele，vascular anastomotic stenosis or thrombosis were observed. Conclusion: Our research indicates that spermatic vein to great saphenous vein bypass is safe and feasible in the treatment of left varicocele secondary to nutcracker syndrome for strictly selected patients，which can effectively alleviate renal vein congestion without significant complications.
