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The Influence of Left Renal Vein Entrapment on Outcome After Surgical Varicocele Repair

A Color Doppler Sonographic Demonstration

Departments of Radiology II (L.P., A.H.S., A.K., H.G.W., W.R., D.z.N., F.F.) and Urology (G.P., R.H., G.B.), University Hospital Innsbruck, Innsbruck, Austria; and Division of Diagnostic Ultrasound, Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania USA (E.J.H.). Revised October 29, 2003. Revised manuscript accepted for publication January 29, 2004.

Address correspondence and reprint requests to Leo Pallwein, MD, Department of Radiology II, University Hospital Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria. E-mail: leo.pallwein{at}uibk.ac.at.

Objective. To evaluate the impact of left renal vein entrapment on outcome after surgical varicocele repair using color Doppler sonography. Methods. Eighty-four men had varicoceles on color Doppler sonography (2 right sided, 74 left sided, and 8 bilateral), which were diagnosed on the basis of a venous diameter of 3 mm or greater and venous retrograde flow in the pampiniform plexus of veins during the Valsalva maneuver or when changing from a supine to an upright position. Diagnosis of the left renal vein entrapment was based on the following criteria: anteroposterior diameter of greater than 1 cm and peak velocity of less than 15 cm/s for the left renal vein at the mid portion and anteroposterior diameter of less than 0.2 cm and peak velocity of greater than 110 cm/s (or, alternatively, a diameter ratio and peak velocity ratio of >5) for the left renal vein between the aorta and superior mesenteric artery. All patients underwent surgical varicocele repair. In postoperative follow-up, we compared the presence of left renal vein entrapment with the frequency of varicocele recurrence. Results. Sixteen (19%) of 84 patients had left renal vein entrapment with a left-sided varicocele. Postoperatively (mean follow-up ± SD, 19.3 ± 11.7 months), 27 (32.2%) of 84 had varicocele recurrence, including all 16 patients with left renal vein entrapment and 11 (20.1%) of 68 patients without left renal vein entrapment. The varicocele recurrence rate was significantly greater in patients with left renal vein entrapment (P < .001, Fisher exact test). Conclusions. The presence of left renal vein entrapment resulted in a significantly higher varicocele recurrence rate. Patients with varicoceles should routinely be evaluated for the presence of left renal vein entrapment before surgical repair.

Key Words: Doppler sonography • nutcracker phenomenon • renal vein entrapment • varicocele

Abbreviations: AP, anteroposterior • LRV, left renal vein • LRVE, left renal vein entrapment • PV, peak velocity • SMA, superior mesenteric artery

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