Abstract Book - 26th ESPU Congress, Joint Meeting with ICCS + SPU + AAP/SOU + AAPU + SFU

VR-20

(VS)

USE OF THE VENOUS COUPLER FOR INTERNAL SPERMATIC TO INFERIOR

EPIGASTRIC SHUNT WITH NUTCRACKER SYNDROME

Joseph ORTENBERG

, Kristi HEBERT

and Hugo ST. HILAIRE

1) Children's Hospital, Urology, New Orleans, USA - 2) Children's Hospital, Plastic Surgery, New Orleans, USA

PURPOSE

The Nutcracker Syndrome (NCS) refers to symptomatic compression of the left renal vein (LRV). This can occur when

the LRV traverses in the normal anatomic position- in the angle between the aorta and the superior mesenteric artery,

or when the LRV is retroaortic - in an anomalous location as can be found in 1.8% of autopsies.

When symptoms such as hematuria, abdominal/pelvic pain or varicocele are sufficiently severe to warrant surgery,

various types of surgical shunts have been utilized. Li et al (1) reported a microsurgical spermatic – inferior epigastric

vein anastomosis in infertile men and Dong et al (2) performed this for adolescents with varicocele and NCS. Both of

these authors utilized more difficult, hand sewn anastomoses. The venous coupler device is used extensively for

microvascular surgery, but has not been reported for correction of NCS.

MATERIAL AND METHODS

A 13 year old boy with a symptomatic varicocele and solitary left testicle had chronic scrotal/abdominal pain. Doppler

LRV sonography and CT scan confirmed a retroaortic LRV as the cause of his NCS, with gonadal and renal venous

dilatation

RESULTS

Through a left inguinal incision, the internal spermatic vein was divided. The distal stump was ligated and the proximal

end of the internal spermatic vein was anastomosed to the inferior epigastric vein in a simplified fashion using the

venous coupler device and this is depicted. On postoperative imaging, the size of the pampiniform plexus and the LRV

normalized and the symptoms completely resolved.

CONCLUSIONS

Adolescents with symptomatic primary or recurrent varicocele should be evaluated for the presence of NCS. When NCS

is present, a venous shunt should be performed and the venous coupler greatly facilitates this procedure.

1) Li H, Zhang M, Jlang Y, Zhang Z, Na W Urology 83: (1) 94 -99, 2014

2) Dong W, Yao Y, Huang H, Han J, Zhao X, Huang J JPUrol 10, 424-429, 2014