The study included an examination of 229 patients (146 men and 83 women, mean age 28.24±2.74) suspected of having SL, who underwent treatment from 1999 to 2021. Patients were randomized into three groups: Group I (109 individuals, 29.42±0.78 years) – patients with aorto-mesenteric compression (AMC) without critical stenosis of the left renal vein (LRV); Group II (44 individuals, 23.65±1.87 years) – patients with critical LRV stenosis (36 of whom underwent surgery, 8 abstained); Group III (78 individuals, 31.66±0.94 years) – control group without AMC. Main complaints: pain in the left side of the abdomen and lower back, chronic pelvic pain, varicocele, left-sided pudendal varicosity, hematuria (episodic, exacerbated by physical exertion). In 62.7% of cases, disease onset occurred during childhood and puberty. Left-sided varicocele was diagnosed in 54.5% of men in Groups I and II: Grade I – 25%, Grade II – 64.5%, Grade III – 10.5%. Left-sided pudendal varicosity was found in 10.7% of women. Erectile dysfunction was observed in 31.8% of men with AMC (86.3% of whom had varicocele). Hemospermia was present in 3.4% of Group II patients. Among women with AMC, dysmenorrhea was detected in 58.5%, dyspareunia in 9.2%. Fertility disorders were found in 9.2% of women and 9.1% of men. Pain assessment using the VAS showed that one-third of Group I patients had no pain syndrome, while the rest experienced mild or moderate pain. In Group II, 93.1% of patients had pain syndrome, with 54.5% experiencing severe pain. The analysis of clinical manifestations identified the main forms of SL: hematuric, venous congestion of the left kidney, pelvic venous congestion, epigastric, and adrenal forms. Doppler ultrasound revealed signs of AMC in 153 patients (66.81%) and critical LRV stenosis in 44 (19.2%). A correlation was found between the LRV diameter in the aorto-mesenteric segment and the peak systolic velocity (PSV) in the stenotic area (r=-0.495, p=0.0854). LRV diameter in the aorto-mesenteric segment: 2.0±0.96 mm (Group II), 3.3±0.43 mm (Group I), 5.2±0.5 mm (Group III). PSV in critical LRV stenosis reached 178.3±18.93 cm/sec versus 34±1.45 cm/sec in the control group (p<0.05). Pelvic varicose veins were diagnosed in 60% of women with AMC. Urinalysis in patients with critical LRV stenosis revealed macrohematuria lasting over 2 years in 32.84% of cases, compared to 4.56% in the control group. Mild anemia was found in five patients with macrohematuria. Proteinuria was present in 6.8% of patients, in two cases combined with hematuria. MSCT angiography showed an average angle of superior mesenteric artery (SMA) departure in patients with critical LRV stenosis of 17.84°0.91°. A scoring system for SL risk assessment was developed, and a treatment strategy was proposed: surgical intervention or conservative therapy. A total of 36 surgical procedures were performed: isolated LRV reimplantation (69.44%), with ligation of the left gonadal vein (19.48%), with left kidney autotransplantation (2.77%), with testiculoiliac anastomosis (5.54%). The effectiveness of three surgical approaches was noted: laparotomic (19.44%), "Mercedes" (58.33%), and subcostal extraperitoneal (22.23%). The average surgery duration was 132.86±11.3 minutes, and hospital stay was 8.34±0.59 days. Early complications included wound complications (11.12%), intestinal paresis (5.56%), anemia (2.78%), and acute renal failure (2.78%). Long-term results (3 months – 21 years): gradual disappearance of pain, hematuria, erectile dysfunction, and dyspeptic symptoms. After LRV reimplantation, the LRV diameter in the aorto-mesenteric segment increased from 1.9±0.87 mm to 7.5±0.76 mm (p=0.0123), and PSV decreased from 187.3±2.95 to 38.7±0.76 cm/sec (p=0.0178). The left gonadal vein diameter decreased from 6.6±1.3 to 4.2±0.84 mm (p=0.0118), and left kidney parenchyma thickness decreased from 2.2±0.46 to 1.6±0.54 mm (p=0.0123). A trend toward slight anastomotic stenosis after 5 years was hemodynamically insignificant. Thus, surgical treatment of SL is effective in correcting venous hypertension, contributing to the regression of clinical manifestations and improving patients' quality of life. Key words: “nutcracker” syndrome, varicose veins of the small pelvis, сhronic inflammatory processes of internal genital organs, chronic pelvic pain, sexual dysfunction, male/female infertility, risk factors, renal hemodynamics, ultrasonographic investigation, computed tomography angiography, quality of life, postoperative period, kidney insufficiency, treatment. Branch-Medicine.
