Varicocele and the Nutcracker Phenomenon: A Contemporary Review of Anatomical Variants and Hemodynamic Consequences

Abstract

About 15–20% of men have varicocele, measured a major cause of male infertility and scrotal discomfort. It is observed by abnormal dilation and tortuosity of the pampiniform plexus veins.  Varicocele can occur because of Nutcracker Syndrome (NCS), a medical condition that includes the compression of the left renal vein (LRV), in an important part specifically in patients with abnormal presentation.  A thorough understanding of the anatomical and hemodynamic connections between both conditions is necessary due to their complicated connection. In the methods Using information from PubMed, Scopus, and other scientific sources, the present systematic review summarizes varicocele and NCS-related epidemiological data, diagnostic criteria, classification schemes, treatment outcomes, and emerging research trends from studies published between 2020 and 2025.The results Up to 36% of males with NCS have left-sided varicocele as their main symptom, according to current data. specialized Doppler parameters that link with the level of venous reflux become a part of the hemodynamic diagnosis of varicoceles. New advances in diagnostic techniques, such as intravascular ultrasound and three-dimensional reconstruction, have helped with the recognition of LRV compression. With success rates ranging from 61% to 92% depending on the intervention, treatments have evolved to include endovascular stenting, microsurgical methods, and customized approaches using three-dimensional printed extravascular stents. In conclusion the complex connection between variations in anatomy and hemodynamic effects is most clearly demonstrated by the link between varicocele and NCS. For the best care of patients, a multidisciplinary approach with new algorithmic diagnosis and customized therapeutic strategies is essential. Establishing standard, the criteria for diagnosis, validating new classification schemes, and creating evidence-based treatment recommendations should be the main goals of future research.