title: Surgical management of nutcracker phenomenon presenting as left varicocele in adolescents: a novel approach.
abstract: OBJECTIVE
  To present a new approach using a shunt operation for the management of nutcracker phenomenon presenting as left varicocele in adolescent patients.
  
  
  METHODS
  12 adolescent patients with the nutcracker phenomenon presenting as left varicocele underwent a shunt operation consisting of anastomosis of the proximal part of the spermatic vein and inferior epigastric vein to lower the left renal vein (LRV) pressure. A simple ligation of the left spermatic vein was then used to repair the varicocele.
  
  
  RESULTS
  12 patients underwent surgery, and symptoms of hematuria, proteinuria, scrotum discomfort, and flank pain disappeared post surgery in all patients. Patients were followed for 24-72 months (mean 48 months). The diameters of the proximal LRV and the peak velocities in the aortomesenteric portion of the LRV were significantly decreased after surgery (p < 0.001). Left testicular volume significantly increased after surgery. One patient had recurrence of the left varicocele and one adolescent had minimal hydrocele requiring no intervention. No major complications were observed during and after surgery.
  
  
  CONCLUSIONS
  Anastomosis of the proximal part of the spermatic vein and inferior epigastric vein is an efficacious and safe surgical approach for the management of nutcracker phenomenon presenting as left varicocele in adolescents.
authors.affiliation: Department of Urology and Radiology (X Z), Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.
authors.forename: Wen
authors.initials: W
authors.lastname: Dong
authors.affiliation: Department of Urology and Radiology (X Z), Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China. Electronic address: yao2146@163.com.
authors.forename: Yousheng
authors.initials: Y
authors.lastname: Yao
authors.affiliation: Department of Urology and Radiology (X Z), Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.
authors.forename: Hai
authors.initials: H
authors.lastname: Huang
authors.affiliation: Department of Urology and Radiology (X Z), Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.
authors.forename: Jinli
authors.initials: J
authors.lastname: Han
authors.affiliation: Department of Urology and Radiology (X Z), Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.
authors.forename: Xinbao
authors.initials: X
authors.lastname: Zhao
authors.affiliation: Department of Urology and Radiology (X Z), Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China. Electronic address: yehjn@yahoo.cn.
authors.forename: Jian
authors.initials: J
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000714:Anastomosis, Surgical / Q000379:methods; D002648:Child; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D059228:Renal Nutcracker Syndrome / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D012082:Renal Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D013085:Spermatic Cord / Q000098:blood supply* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography; D013521:Urologic Surgical Procedures, Male / Q000379:methods*; D014646:Varicocele / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D014680:Veins / Q000601:surgery
keywords: Adolescent; Nutcracker phenomenon; Shunt operation; Varicocele