The relationship between May-Thurner syndrome and varicocele in men: a narrative review

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Abstract

May-Thurner syndrome (MTS), defined by compression of the left common iliac vein, increases left gonadal-vein pressure and may underlie otherwise varicoceles. This narrative review synthesises 25 relevant publications: case reports, series, observational and interventional studieas. Pooled evidence indicates that 67–90% of men with varicocele exhibit at least 25% iliac-venous compression, and that successful iliac stenting leads to regression of varicocele symptoms and improved fertility. The diagnostic value of combining duplex ultrasound with computed tomographic/magnetic resonance venography is highlighted, whereas catheter venography with intravascular ultrasound remains the reference for confirming haemodynamic significance. Gaps in data regarding long-term stent patency and the epidemiology of MTS in asymptomatic males have been identified. It advocates systematic iliac-vein assessment in men presenting with recurrent or bilateral varicocele and calls for prospective multicentre trials comparing surgical ligation with endovascular correction.

About the authors

Vladimir A. Vorobev

Irkutsk State Medical University; Bashkir State Medical University

Author for correspondence.
Email: denecer@yandex.ru
ORCID iD: 0000-0003-3285-5559
SPIN-code: 9896-6243

D. Sci. (Med.)

Russian Federation, Irkutsk; Ufa

A. P. Chemezov

Irkutsk State Medical University; Irkutsk Order of the Badge of Honor Regional Clinical Hospital

Email: denecer@yandex.ru
ORCID iD: 0009-0009-0939-8186

Urologist-Andrologist

Russian Federation, Irkutsk; Irkutsk

Kirill M. Su-Yanz

Irkutsk State Medical University

Email: denecer@yandex.ru
ORCID iD: 0009-0005-9143-916X

Student

Russian Federation, Irkutsk

Amirkhon Kh. Iakubov

Irkutsk State Medical University

Email: denecer@yandex.ru
ORCID iD: 0009-0006-2892-0900

Student

Russian Federation, Irkutsk

References

  1. Jeon UB, Chung JW, Jae HJ, et al. May-Thurner Syndrome Complicated by Acute Iliofemoral Vein Thrombosis: Helical CT Venography for Evaluation of Long-Term Stent Patency and Changes in the Iliac Vein. Am J Roentgenol. 2010;195:751-7. doi: 10.2214/ajr.09.2793
  2. May R, Thurner J. The cause of the predominantly sinistral occurrence of thrombosis of the pelvic veins. Angiology. 1957;8:419-27. doi: 10.1177/000331975700800505.
  3. Fang Y, Su Y, Xu J, et al. Varicocele-Mediated Male Infertility: From the Perspective of Testicular Immunity and Inflammation. Front Immunol. 2021;12:729539. doi: 10.3389/fimmu.2021.729539
  4. Chin P, Villalba L. PD18-09 the incidence of left common iliac vein compression in men with a varicocele. Implications for etiology and management. J Urol. 2023;209. doi: 10.1097/ju.0000000000003273.09
  5. Абуев Г.Г., Кызласов П.С., Капто А.А., и др. Случай успешной фертилизации пациента с двусторонним варикоцеле на фоне синдрома Мея-Тернера путем сочетания трансскротальной варикоцелэктомии с рентгенэндоваскулярной коррекцией компрессии подвздошных сосудов. Урологические ведомости. 2023;13:303-10 [Abuev GG, Kyzlasov PS, Kapto AA, et al. A case of successful fertility of a patient with bilateral varicocele on the background of May-Thurner syndrome by combining transscrotal varicocelectomy with X-ray endovascular correction of iliac vessel compression. Urology Reports (St – Petersburg). 2023;13:303-10 (in Russian)]. doi: 10.17816/uroved568029
  6. Infertility Prevalence Estimates, 1990–2021 n.d. Available at: https://www.who.int/publications/i/item/978920068315. Accessed: 25.04.2025.
  7. Schlegel PN. Is assisted reproduction the optimal treatment for varicocele-associated male infertility? A cost-effectiveness analysis. Urology. 1997;49:83-90. doi: 10.1016/S0090-4295(96)00379-2
  8. Chiles KA, Schlegel PN. Cost-effectiveness of varicocele surgery in the era of assisted reproductive technology. Asian J Androl. 2016;18:259-61. doi: 10.4103/1008-682X.172644
  9. Algharras A, Rchdeih A, Altwigry AM, Alsamal M. May-Thurner Syndrome Causing Unilateral Varicocele Treated With Endovascular Embolization. Cureus. 2024;16:e73490. doi: 10.7759/cureus.73490
  10. Farina R, Foti PV, Iannace FA, et al. May-Thurner Syndrome with Double Compression of the Iliac Vein: Lessons Based on a Case Report. Am J Case Rep. 2021;22:e928957. doi: 10.12659/AJCR.928957
  11. Simonds E, Patel M, Vetter M, et al. May-Thurner Syndrome Variant Identified in a Cadaver: First Reported Case. Cureus. 2018;10:e2396. doi: 10.7759/cureus.2396
  12. Chin P, Villalba L, Huang S, Osei-Tutu L. MP46-14 varicocele and may-thurner syndrome: the etiological link. J Urol. 2019;201. doi: 10.1097/01.ju.0000556306.49485.ac
  13. Gat Y, Zukerman Z, Chakraborty J, Gornish M. Varicocele, hypoxia and male infertility. Fluid Mechanics analysis of the impaired testicular venous drainage system. Human Reprod. 2005;20:2614-9. doi: 10.1093/humrep/dei089
  14. Mohamadi A, Ghasemi-Rad M, Mladkova N, Masudi S. Varicocele and Nutcracker Syndrome. J Ultrasound Med. 2010;29:1153-60. doi: 10.7863/jum.2010.29.8.1153
  15. Unlu M, Orguc S, Serter S, et al. Anatomic and hemodynamic evaluation of renal venous flow in varicocele formation using color Doppler sonography with emphasis on renal vein entrapment syndrome. Scand J Urol Nephrol. 2007;41:42-6. doi: 10.1080/00365590600796659
  16. Alkan E, Inal HA, Gonen M, Tolu I. The relationship between saphenofemoral junction insufficiency and varicocele. Andrologia. 2020;52. doi: 10.1111/and.13820
  17. Farhadi S, Jalili J, Shakeri Bavil Olyaei A, et al. Is There a Link Between Saphenofemoral Insufficiency and Varicocele: Imaging Study of Sub-Fertile Men. Nephro-Urol Monthly. 2020;12. doi: 10.5812/numonthly.99178
  18. Берлизева О.Ю., Амосов А.В., Абоян И.А., и др. Эндоваскулярные вмешательства у мужчин с синдромом хронической тазовой боли на фоне вторичной варикозной болезни вен малого таза. Урология. 2021;2:46-50 [Berlizeva OU, Aboyan IA, Amosov AV, et al. Endovascular treatment of secondary varicose veins of the pelvis in me n with chronic pelvic pain syndrome. Urologiia. 2021;2:46-50 (in Russian)]. doi: 10.18565/urology.2021.2.46-50
  19. Dalla S, Diaz J, El-Swais A, et al. Positional priapism and scrotal swelling: An unusual presentation of IVC filter associated thrombosis and May-Thurner syndrome. Radiol Case Rep. 2024;19:3605-9. doi: 10.1016/j.radcr.2024.05.059
  20. Kumar V, Michelle K, Bhavyakumar V, Dhir S. May-Thurner Syndrome – a Rare Cause of Extensive Pelvic DVT, but Is there More to Know? Case Rep Vascular Med. 2022. doi: 10.1155/2022/7978470
  21. Povelitsa EА, Bystrenkov AV, Shesternya AM, Parkhomenko OB. Endovascular correction of venogenic erectile dysfunction in May-Thurner syndrome (clinical case). Androl Genital Surg. 2019;20:45-51. doi: 10.17650/2070-9781-2019-20-4-45-51
  22. Meeus R, Dhondt P, Beunens S, Khan MA. Ipsilateral Double May-Thurner Syndrome With a Congenital Double Left Common Iliac Vein: A Case Report of an Unprecedented Anatomical Variant and Hemodynamic Interaction. Cureus. 2024;16:e74633. doi: 10.7759/cureus.74633
  23. Жуков О.Б., Уколов В.А., Бабушкина Е.В., Евдокимов В.В. Рецидивирующее варикоцеле и синдром May-Thurner. Вестник урологии. 2018;6:17-25 [Zhukov OB, Ukolov VA, Babushkina EV, Evdokimov VV. Recurrent varicocele and May-Thurner syndrome. Vestnik Urologii. 2018;6:17-25 (in Russian)]. doi: 10.21886/2308-6424-2018-6-3-17-25
  24. Капто А.А., Виноградов И.В., Харпунов В.Ф., и др. Отдаленные результаты первого опыта лечения мужчины с синдромом Мея-Тюрнера и варикозной болезнью вен органов малого таза. Урология. 2019:114-21 [Kapto AA, Vinogradov AND V, Harpunov In F, Mammadov RE, Smyslov ZA. Long-term results of the first treatment experience of a man with Meya-Turner syndrome and varicose veins of the pelvic organs. Urologia. 2019;114-21 (in Russian)]. doi: 10.18565/urology.2019.3.114-121
  25. McGilvray MMO, Balderman J, Jayarajan SN. Successful left gonadal vein to inferior vena cava bypass for symptomatic May-Thurner syndrome. J Vascular Surg Cases Innovations Techniques. 2019;5:549-52. doi: 10.1016/j.jvscit.2019.07.008

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