ESPN 51th Annual Meeting

ESPN 2018


 
Nutcracker Syndome and Varicocele
FATMA SEMSA CAYCI 1 SUAT FITÖZ 2 TARKAN SOYGÜR 3 BERK BURGU 3 PERVIZ HACIYEV 3 DIDEM EDA ŞÜKÜR KURT 4 MESIHA EKIM 4

1- DEPARTMENT OF PEDIATRIC NEPHROLOGY, ANKARA CHILD HEALTH HEMATOLOGY, ONCOLOGY EDUCATION AND RESEARCH HOSPITAL, ANKARA, TURKEY.
2- DEPARTMENT OF PEDIATRIC RADIOLOGY, FACULTY OF MEDICINE, ANKARA UNIVERSITY, TURKEY.
3- DEPARTMENT OF UROLOGY, DIVISION OF PEDIATRICS, UNIVERSITY OF ANKARA FACULTY OF MEDICINE, ANKARA, TURKEY.
4- DIVISION OF PEDIATRIC NEPHROLOGY, DEPARTMENT OF PEDIATRICS, ANKARA UNIVERSITY SCHOOL OF MEDICINE, ANKARA, TURKEY
 
Introduction:

 Nutcracker syndrome (NCS) is entrapment of the left renal vein (LRV) between the aorta and superior mesenteric artery (SMA). The symptoms vary from asymptomatic hematuria, proteinuria to varicocele. This syndrome is frequently associated with low Body mass index (BMI). Hematuria and proteinuria can be resolved by an improvement of a Nutcracker phenomenon in accordence with an increase in BMI during childhood. It has also reported that LRV compression by the SMA is a major contributor to left-sided varicoceles and increasing BMI may play a protective role in the development of varicocele. The frequency of left sided varicocele in NCS was reported as 29% of the male patients. Here we want to take attention of varicocele in NCS.

Material and methods:

Files of patients who had been diagnosed as NCS in Ankara University School of Medicine Department of Pediatric Nephrology from 2005 to 2018 were reviewed, retrospectively. BMI was calculated as weight (kg)/height squared (m (2)).

Results:

 A total of 107 (39 boys and 68 girls) patients were enrolled. The mean age on diagnosis for the whole group was 11.6±2.99 years. The following frequency of symptoms was: 9% for haematuria, 40% for abdominal pain, 23% for varicocele in males and19% for proteinuria. There are 9 patient with varicocele. BMI for whole group was 16.9±2.55 and 18.9±1.2 for boys with varicocele. Proteinuria for varicocele patients were 22±29 mg/m2/hour and 14±11 mg/m2/hour for boys without variococele. Proteinuria did not change between patients with and without varicocele (p=0.9). During the follow-up period three of them (33.3%) also underwent operation for varicocele.

Conclusions:

In cases of unexplained hematuria and/or proteinuria clinicians should consider the diagnosis of Nutcracker syndrome. Varicocele should also be evaluated in boys with Nutcracker syndrome. There is a need for further studies to verify the effect of Nutcracker syndrome on varicocele formation.