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Eighteen years of experience with pediatric nutcracker syndrome: the importance of the conservative approach

Published:December 07, 2019DOI:https://doi.org/10.1016/j.jpurol.2019.12.003

      Summary

      Introduction

      Nutcracker syndrome (NS) defines an entity generated by the compression of the left renal vein resulting in venous hypertension, which transmitted in a retrograde direction may cause hematuria, proteinuria, and varicocele. The literature concerning exclusively pediatric patients is very rare.

      Objective

      To report the authors' experience with pediatric NS in the last 18 years.

      Study design

      This is a retrospective review of the patients followed up in the authors' center with diagnosis of NS based on clinical and imaging tests (ultrasound, computed tomography/magnetic resonance imaging, and phlebography). The primary outcome was the success of the conservative approach in the study patients.

      Results and Discussion

      A total of 21 patients were diagnosed with NS and followed up for a mean period of 52.3 months (37.1–67.5). The mean age at diagnosis was 11.7 years (9.9–13.4). The most frequent symptom of presentation was hematuria in 16 patients (76.2%), being macroscopic in 75% patients and related to physical exercise in 42.9% patients. Other symptoms were left varicocele in 7 patients (33%) and proteinuria in 6 patients (28.6%). Mild to moderate cases received conservative treatment (change of physical activity, postural hygiene), which achieved resolution of symptoms in 16 patients (76.2%). Five cases (23.8%) finally needed a more aggressive approach. Two (9.5%) of them required endovascular procedures (intravascular stent in the renal vein in 1 case and embolization of the spermatic vein in 1 case); in one (4.8%) of the patients, transposition of the left renal vein and kidney autotransplantation were performed, and 2 (9.5%) of the patients with mild cases required surgical correction of the varicocele.

      Conclusions

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      Keywords

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