In 20 patients of varicocele, both transscrotal and transfemoral phlebography to visualize the left renal, internal :spermatic and common iliac vein were performed during period from August, 1981 to March, 1982. The following results were obtained.
1. Among 14 pts. with passive reflux from the renal vein to the internal spermatic vein, proximal nutcracker phenomenon was observed in 10 patients, distal nutcracker phenomenon in 8 and both in 4.
2. Passive reflux to the internal spermatic vein without other abnormalities on phlebography was observed in 4 patients. Recurrent varicocele in 3 patient in this group who showed dilated duplicated internal spermatic veins were managed successfully by repeated high ligation.
3. In 2 patients showing renal-spermatic shunting vein and proximal nutcracker phenomenon concurrently, high ligation was performed distal to the point of the communication of shunting vein to the internal spermatic vein.
4. 8 patients with distal nutcracker phenomenon associated with passive reflux from the renal vein to the internal spermatic vein, I patient with distal nutcracker phenomenon and renal-spermatic shunt and 5 patients with normal venography were treated by ligation of internal spermatic vein, external spermatic vein and deferential vein through inguinal incision.
5. 1 patient with distal nutracker phenomenon without other abnormalities was managed by ligation of external spermatic and deferential vein at the level of internal inguinal ring.
6. Use of routine preoperative venography is essential to establish the etiology of the varicocele and its proper management.
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