Microscopic ligation combined with shunt procedure versus microsurgical varicocelectomy for nutcracker syndrome and left varicocele: a randomized controlled trial

This study is to evaluate the safety and efficacy of a novel microsurgical approach (Microsurgical Spermatico-Inferior Epigastric Vein Anastomosis with Selective Venous Disconnection, MSEA-SVD) compared to conventional Microsurgical Varicocelectomy approach in patients with Nutcracker Syndrome and left-sided varicocele. This single-center, randomized controlled trial enrolled 50 patients (25 per group) diagnosed with Nutcracker Syndrome and left-sided varicocele. Group A underwent MSEA-SVD, while Group B received Microsurgical Varicocelectomy. The primary outcomes included semen quality, renal vein hemodynamics, and varicocele recurrence. Follow-up assessments were conducted at 1, 3, and 6 months postoperatively using color Doppler ultrasound and semen analysis. Statistical comparisons were performed using IBM SPSS 27.0. MSEA-SVD achieves superior outcomes in semen quality and renal vein decompression compared to Microsurgical Varicocelectomy but requires a longer surgery time and hospitalization. With careful patient selection, MSEA-SVD may become a preferred approach for managing Nutcracker Syndrome-related varicocele.