Ouskri Salim, Ziani Idriss, El Aboudi Adam, Ibrahimi Ahmed, El Sayegh Hachem, Nouini Yassine
Ibn Sina Hospital, Morocco.
Ibn Sina Hospital, Morocco.
Int J Surg Case Rep. 2025 Jun;131:111336. doi: 10.1016/j.ijscr.2025.111336. Epub 2025 Apr 21.
Varicocele is a common condition that can cause male infertility and chronic scrotal pain. While most cases are idiopathic, secondary causes such as Nutcracker Syndrome (NCS) should be considered in atypical presentations, especially when hematuria is present.
A 22-year-old male presented with chronic left scrotal pain and intermittent hematuria. Physical examination and Doppler ultrasound confirmed a grade III left varicocele. Further imaging with CT angiography revealed NCS, characterized by left renal vein compression. Due to the mild nature of NCS symptoms and the patient's preference to avoid major surgery, only a varicocelectomy via the Ivanissevich technique was performed.
Secondary varicoceles require careful evaluation to rule out underlying causes such as NCS. Treatment varies based on symptom severity, with options ranging from conservative management to surgical intervention. In cases where NCS is mild, varicocelectomy alone can effectively relieve scrotal pain.
NCS should be considered in patients with varicocele and hematuria. While major interventions may be necessary in severe cases, isolated varicocelectomy can be an effective treatment for pain relief in selected patients.
精索静脉曲张是一种常见病症，可导致男性不育和慢性阴囊疼痛。虽然大多数病例是特发性的，但在非典型表现中，尤其是出现血尿时，应考虑诸如胡桃夹综合征（NCS）等继发性病因。
一名22岁男性出现慢性左侧阴囊疼痛和间歇性血尿。体格检查和多普勒超声证实为左侧III级精索静脉曲张。通过CT血管造影进一步成像显示为NCS，其特征为左肾静脉受压。由于NCS症状较轻且患者倾向于避免大型手术，仅通过伊万尼塞维奇技术进行了精索静脉高位结扎术。
继发性精索静脉曲张需要仔细评估以排除诸如NCS等潜在病因。治疗方法根据症状严重程度而异，选择范围从保守治疗到手术干预。在NCS较轻的病例中，单独进行精索静脉高位结扎术可有效缓解阴囊疼痛。
精索静脉曲张合并血尿的患者应考虑NCS。虽然严重病例可能需要进行重大干预，但对于部分患者，单纯精索静脉高位结扎术可以是缓解疼痛的有效治疗方法。
