Diagnosis and surgical treatment of nutcracker syndrome (Report of 3 cases)

Objective:To study the clinical features, the diagnosis and treatment of nutcracker syndrome. To assess the therapeutic value of left renal vein transposition for treatment of the nutcracker syndrome.Methods:Three patients (2 men and 1 woman) between 14 and 23 years old (mean 18.7) with nutcracker syndrome were reported. The clinical features were characterized by recurrent episodes of hematuria or proteinuria, and 1 case had left varicocele. Cystoscopy showed hematuria from the left ureter orifice. Doppler ultrasound and CT scan showed that the left renal vein was clearly compressed at the included angle of abdominal aorta and superior mesenteric artery. All three patients received left renal vein transposition.Results:In three patients who underwent left renal vein transposition, no perioperative complications were encountered. During the follow-up of 6-9 months, CT and Doppler ultrasound showed that the reconstructed veins were patent, and the routine urine test results were normal.Conclusions:Hematuria, proteinuria and left varicocele are important clinical symptoms of the nutcracker syndrome. Doppler ultrasound and CT are useful screening tools in patients with suspected nutcracker syndrome. Transposition of the left renal vein is an efficient surgical approach with an acceptable risk of complications.