Testicular vein syndrome and its treatment with a laparoscopic approach

Abstract

Background and objectives: Testicular vein syndrome (TVS) is a rare cause of ureteral obstruction. Only 5 previous cases are on record in the literature, and no review exists on this topic to date. Laparoscopic treatment has never been mentioned in the management of TVS.

Materials and methods: We reviewed the literature related to this unusual entity to clarify the preoperative evaluation and the management of TVS. For this purpose, the data related to all the 5 cases previously reported so far in the English literature have been reviewed. Also, we report the sixth case of TVS, and the first patient to be successfully treated with the laparoscopic approach. This was a 37-year-old male with a 6-month history of left loin pain. Preoperative diagnosis was confirmed by CT-Urography.

Results: Our patient underwent laparoscopic excision of the left testicular vein followed by ureteroureterostomy in a single sitting. The laparoscopic transperitoneal approach was used. Histopathological examination of the vein showed normal venous tissue. This is the sixth reported case of TVS and the first to be successfully treated with a laparoscopic technique.

Conclusions: A laparoscopic approach is safe and effective for treating patients with TVS with the common advantages of minimal invasiveness and better visualization of the complex anatomy of the retroperitoneum. Thus, it should be the treatment of choice for TVS.

Figure 1.

Intravenous urography (IVU) shows mild left hydronephrosis with dilatation of the proximal ureter up to the level of the third lumbar vertebra (L3), and lesser passage of the contrast distal to the level of obstruction.

Figure 2.

Intravenous contrast-enhanced CT-urography. (A) Volume randomized tomography image during the excretory phase reveals mild left hydronephrosis with dilatation of the proximal ureter up to the level of an abrupt narrowing in caliber (white arrow), and poor passage of the contrast into the ureteral segment distal to the obstruction. (B) Paracoronal section during the excretory phase combined with predominant venous phase shows compression of the left ureter by a vascular structure crossing anteriorly (single yellow arrow). Below the level of obstruction, the caliber of the left ureter is normal (double yellow arrow).

Figure 3.

The port placement for laparoscopic treatment of left TVS. The numbers in the circles (below each port site) depict the order of insertion of the port at that site.

Figure 4.

A & B. Intraoperative photographs of laparoscopic treatment of left TVS (Right hand side of the images is the cephalic, and left hand side is caudal of the patient); (A) The left testicular vein crossing anterior to the left ureter (double arrow) causing compression of the underlying ureter resulting in dilatation of its proximal segment (*). (B) The left testicular vein has been ligated with vascular clips, cut and its proximal and distal ends (upper and lower single arrows) have been separated to show the compressed segment of the left ureter.