Microscopic spermatic vein ligation and internal spermatic vein-inferior epigastric vein bypass surgery for 7 cases of severe varicocele complicated with nutcracker syndrome

Abstract

Objective To explore the clinical effect of microscopic spermatic vein ligation and internal spermatic vein-inferior epigastric vein bypass surgery in the treatment of severe left varicocele (VC) complicated with nutcracker syndrome (NCS). Methods The clinical data of 7 cases of left VC complicated with NCS treated in our hospital from October, 2016 to October, 2018 by microscopic ligation were analyzed. They were confirmed by CDFI and CT before the operation, and were treated by microscopic spermatic vein ligation and internal spermatic vein-inferior epigastric vein bypass surgery. After the operation, they were rechecked by CDFI and routine urianlysis, their urinary erythrocyte phases, kidney function, and semen parameters were detected. All the patients were followed up 4-24 months. The clinical symptoms, stoma patency, spermatic vein diameter, sperm quality, and postoperative recurrence rate were compared between before and 4 months after the operation. Results All the 7 patients had successful operation. After the operation, their waist pain, scrotal distention, hematuria, proteinuria, etc. disappeared. 4 cases took semen examination, and 2 were improved in sperm concentration and activity, and the other 2 were still normal. B ultrasound showed no reversed flow in venae spermatica. No recurrence occurred after the operation. Conclusion Microscopic spermatic vein ligation and internal spermatic vein-inferior epigastric vein bypass surgery can alleviate clinical symptoms, improve semen quality, mitigate damage to testicles, and protect renal function. It is recommended to treat VC complicated with NCS, with the merits of simplication, effectiveness, small wound, and early recovery. Key words: Varicocele; Nutcracker syndrome; Microscopy; Spermatic vein ligation; Internal spermatic vein-inferior epigastric vein bypass surgery