Spermatic-inferior Epigastric Vein Anastomosis For The Treatment Of Nutcracker Syndrome(NCS)-associated Varicocele In Infertile Men

Objective: To assess the therapeutic effectiveness ofmicrosurgical spermatic-inferior epigastric vein anastomosisfor the treatment of nutcracker syndrome (NCS)-associatedvaricocele in infertile men.Methods: We prospectively analyzed five infertile men withNCS-associated varicocele between September2012and March2013. All5patients were type tall young male, the average ageis27years old（Among the3cases of hematuria,1cases of flankpain patients, all the patients showed poor sperm quality）。All patients underwent microsurgical spermatic-inferiorepigastric vein anastomosis.Results: The mean operation time was90.0±10.2min, and themean postoperative hospital stay was7.0±0.5d. During a1-year follow-up, hematuria completely resolved in66.7%(2/3)of patients and flank pain resolved in the single affected. Thepeak velocity (PV) at the aortomesenteric portion of the leftrenal vein (LRV) significantly decreased after surgery (150.75±45.70cm/s vs.49.20±3.55cm/s).The PV ratio between theaortomesenteric and hilar portion of LRV also significantlydecreased (10.98±3.20vs.3.10±0.75cm/s). The mean spermcount and motility at3(20.52±5.26×106/ml，45.50±9.27%, respectively) at6months (25.49±2.69×106/ml，64.07%±7.39%, respectively) and12months (31.13±4.63×106/ml，65.51±9.60%, respectively) postoperatively weresignificantly higher than their preoperative values (15.8×106/ml±4.53×106/ml and26.76%±8.68%, respectively).Overall,80%(4/5) of spouses of patients went on to conceivenaturally. The complications observed were scrotal edema in onepatient (20%) and wound infection in one patient (20%).Conclusion:Microsurgical spermatic-inferior epigastricvein anastomosis is a safe and efficient surgical treatment forinfertile men with NCS-associated varicocele.