title: Microsurgical spermatic-inferior epigastric vein anastomosis for treating nutcracker syndrome-associated varicocele in infertile men: a preliminary experience.
abstract: OBJECTIVE
  To assess the therapeutic effectiveness of microsurgical spermatic-inferior epigastric vein anastomosis for the treatment of nutcracker syndrome (NCS)-associated varicocele in infertile men.
  
  
  METHODS
  We prospectively analyzed 5 infertile men with NCS-associated varicocele between April 2010 and January 2012. All patients underwent microsurgical spermatic-inferior epigastric vein anastomosis.
  
  
  RESULTS
  The mean operation time was 85.0 ± 13.2 minutes, and the mean postoperative hospital stay was 6.0 ± 0.7 days. During a 1-year follow-up, hematuria completely resolved in 66.7% of patients (2/3) and flank pain resolved in the single patient affected. The peak velocity (PV) at the aortomesenteric portion of the left renal vein (LRV) significantly decreased after surgery (167.24 ± 41.68 cm/s vs 46.98 ± 4.22 cm/s). The PV ratio between the aortomesenteric and hilar portion of the LRV also significantly decreased (12.28 ± 2.32 preoperatively vs 3.40 ± 0.67 postoperatively). The mean sperm count and motility at 6 months (24.38 × 10(6)/mL ± 1.58 × 10(6)/mL and 53.96% ± 6.28%, respectively) and 12 months (30.02 × 106/mL ± 3.52 × 106/mL and 59.40% ± 8.59%, respectively) postoperatively were significantly higher than their preoperative values (15.8 × 106/mL ± 4.53 × 106/mL and 26.76% ± 8.68%, respectively). Overall, 80% of the spouses of patients (4/5) went on to conceive naturally. The complications observed were scrotal edema in 1 patient (20%) and wound infection in 1 patient (20%).
  
  
  CONCLUSIONS
  Microsurgical spermatic-inferior epigastric vein anastomosis is a safe and efficient surgical treatment for infertile men with NCS-associated varicocele.
authors.affiliation: Department of Urology, China and Japan Union Hospital of Jilin University, Changchun City, Jilin Province, China.
authors.forename: Hai
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Urology, China and Japan Union Hospital of Jilin University, Changchun City, Jilin Province, China.
authors.forename: Muchun
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Department of Colon, China and Japan Union Hospital of Jilin University, Changchun City, Jilin Province, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: Department of Urology, China and Japan Union Hospital of Jilin University, Changchun City, Jilin Province, China.
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Urology, China and Japan Union Hospital of Jilin University, Changchun City, Jilin Province, China. Electronic address: 895491670@qq.com.
authors.forename: Wanli
authors.initials: W
authors.lastname: Na
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D006801:Humans; D007248:Infertility, Male / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008866:Microsurgery; D011446:Prospective Studies; D059228:Renal Nutcracker Syndrome / Q000150:complications*; D013521:Urologic Surgical Procedures, Male / Q000379:methods; D014646:Varicocele / Q000209:etiology* / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods; D014680:Veins / Q000601:surgery*; D055815:Young Adult