Study On The Relationship Between Varicocele And Nutcracker Phenomenon

Object:Varicocele is a vascular lesion commonly associated with infertility. Its etiology is only partly understood, hence, the purpose of the study was to establish its correlation with intrinsic anatomic differences and nutcracker phenomenon and to explore diagnosis and treatment of varicocele combined with nutcracker phenomenon.Methods:A total of43patients with varicocele and43patients without varicocele were enrolled. The diagnosis of varicocele was based on physical examination, followed by sonographic evaluation of the hilar portion and aortomesenteric portion (AMP) of the left renal vein (LRV). The anteroposterior diameter in millimeters and peak flow in centimeters per second in each region were measured. Patients with varicocele combined with nutcracker phenomenon underwent spiral CT and semen examination, laparoscopic left varicocele was done in8patients.Results:A total of12patients with the nutcracker phenomenon were identified in the study group (27.9%), and1were identified in the control group (2.32%). The mean diameters of the hilar portion and AMP of the LRV were significantly different in varicocele-affected patients compared with the control group (7.28±1.39mm vesus6.21±0.87mm;1.64±0.64mm vesus2.28±0.36mm)(P<0.01). The mean peak velocities in the hilar portion and AMP were significantly different in patients with varicocele (20.59±3.87cm/s vesus25.76±4.39cm/s;88.61±22.79cm/s vesus62.79±17.84cm/s)(P<0.01). Patients with varicocele and nutcracker phenomenon did not have a significant difference in either the hilar or AMP diameter compared with patients with varicocele without nutcracker phenomenon. They had a significant difference in both the hilar and AMP peak flow velocity (P<0.01). Eight cases were followed-up6months after operation, semen quality improved.Conclusion:Our findings indicate that nutcracker phenomenon is a frequent finding in varicocele-affected patients and should be routinely excluded as a possible cause of varicocele. In addition, intrinsic anatomic differences in the AMP and hilar portion of the LRV could be directly responsible for the onset of varicocele. Laparoscopic varicocele ligation could improve semen quality in patients with varicocele combined with nutcracker phenomenon.