The influence of left renal vein entrapment on outcome after surgical varicocele repair: a color Doppler sonographic demonstration.
OBJECTIVE
To evaluate the impact of left renal vein entrapment on outcome after surgical varicocele repair using color Doppler sonography.


METHODS
Eighty-four men had varicoceles on color Doppler sonography (2 right sided, 74 left sided, and 8 bilateral), which were diagnosed on the basis of a venous diameter of 3 mm or greater and venous retrograde flow in the pampiniform plexus of veins during the Valsalva maneuver or when changing from a supine to an upright position. Diagnosis of the left renal vein entrapment was based on the following criteria: antero-posterior diameter of greater than 1 cm and peak velocity of less than 15 cm/s for the left renal vein at the mid portion and anteroposterior diameter of less than 0.2 cm and peak velocity of greater than 110 cm/s (or, alternatively, a diameter ratio and peak velocity ratio of >5) for the left renal vein between the aorta and superior mesenteric artery. All patients underwent surgical varicocele repair. In postoperative follow-up, we compared the presence of left renal vein entrapment with the frequency of varicocele recurrence.


RESULTS
Sixteen (19%) of 84 patients had left renal vein entrapment with a left-sided varicocele. Postoperatively (mean follow-up +/- SD, 19.3 +/- 11.7 months), 27 (32.2%) of 84 had varicocele recurrence, including all 16 patients with left renal vein entrapment and 11 (20.1%) of 68 patients without left renal vein entrapment. The varicocele recurrence rate was significantly greater in patients with left renal vein entrapment (P < .001, Fisher exact test).


CONCLUSIONS
The presence of left renal vein entrapment resulted in a significantly higher varicocele recurrence rate. Patients with varicoceles should routinely be evaluated for the presence of left renal vein entrapment before surgical repair.
Pallwein
Leo
L
Department of Radiology II, University Hospital Innsbruck, Innsbruck, Austria. leo.pallwein@uibk.ac.at
Pinggera
Germar
G
Schuster
Antonius H
AH
Klauser
Andrea
A
Weirich
Harald G
HG
Recheis
Wolfgang
W
Herwig
Ralf
R
Halpern
Ethan J
EJ
Bartsch
Georg
G
zur Nedden
Dieter
D
Frauscher
Ferdinand
F
D000328:Adult; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D012082:Renal Veins / Q000000981:diagnostic imaging; D018615:Ultrasonography, Doppler, Color; D014646:Varicocele / Q000601:surgery*