Microsurgical spermatic-inferior epigastric vein anastomosis for treating nutcracker syndrome-associated varicocele in infertile men: A preliminary experience

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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 × 106/mL ± 1.58 × 106/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%). Conclusion Microsurgical spermatic-inferior epigastric vein anastomosis is a safe and efficient surgical treatment for infertile men with NCS-associated varicocele.

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Li, H., Zhang, M., Jiang, Y., Zhang, Z., & Na, W. (2014). Microsurgical spermatic-inferior epigastric vein anastomosis for treating nutcracker syndrome-associated varicocele in infertile men: A preliminary experience. Urology, 83(1), 94–99. https://doi.org/10.1016/j.urology.2013.08.050

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