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Nutcracker phenomenon
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== Epidemiology == Nutcracker syndrome/phenomenon is often described as "rare" in the medical literature, even though there's research indicating that it's a severely under-diagnosed condition.<ref name="Kurklinsky2010" /><ref name="Scholbach2007" /><ref name=":11">{{Cite web|url=https://rarediseases.info.nih.gov/diseases/11971/renal-nutcracker-syndrome | title = Renal nutcracker syndrome {{!}} Genetic and Rare Diseases Information Center (GARD) – an NCATS Program|website=rarediseases.info.nih.gov|access-date=2020-05-01}}</ref><ref name="Poyraz2013">{{Cite journal | last = Poyraz | first = Ahmet K | last2 = Firdolas | first2 = Fatih | last3 = Onur | first3 = Mehmet R | last4 = Kocakoc | first4 = Ercan | date = Mar 2013 | title = Evaluation of left renal vein entrapment using multidetector computed tomography|url=https://journals.sagepub.com/doi/10.1258/ar.2012.120355|journal=Acta Radiologica|language=en-US|volume=54|issue=2|pages=144–148|doi=10.1258/ar.2012.120355|issn=0284-1851}}</ref> Varicocele is a known complication of nutcracker phenomenon.<ref name="Kurklinsky2010" /> Between 9.5%<ref name="Kurklinsky2010" /> and 15%<ref>{{Cite journal | last = Kupis | first = Łukasz | last2 = Dobroński | first2 = Piotr Artur | last3 = Radziszewski | first3 = Piotr | date = 2015 | title=Varicocele as a source of male infertility – current treatment techniques|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4643713/|journal=Central European Journal of Urology|volume=68|issue=3|pages=365–370|doi=10.5173/ceju.2015.642|issn=2080-4806|pmc=4643713|pmid=26568883}}</ref> of all men globally are affected by varicocele. According to two separate studies, 30%<ref>{{Cite journal | last = Mohamadi | first = Afshin | last2 = Ghasemi-Rad | first2 = Mohammad | last3 = Mladkova | first3 = Nikol | last4 = Masudi | first4 = Sima | date = 2010 | title=Varicocele and Nutcracker Syndrome|url=https://onlinelibrary.wiley.com/doi/abs/10.7863/jum.2010.29.8.1153|journal=Journal of Ultrasound in Medicine|language=en|volume=29|issue=8|pages=1153–1160|doi=10.7863/jum.2010.29.8.1153|issn=1550-9613}}</ref> to 100%<ref>{{Cite journal | last = Unlu | first = Murat | last2 = Orguc | first2 = Sebnem | last3 = Serter | first3 = Selim | last4 = Pekindil | first4 = Gokhan | last5 = Pabuscu | first5 = Yuksel | date = 2007 | title=Anatomic and hemodynamic evaluation of renal venous flow in varicocele formation using color Doppler sonography with emphasis on renal vein entrapment syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/17366101/|journal=Scandinavian Journal of Urology and Nephrology|volume=41|issue=1 | pages = 42–46|doi=10.1080/00365590600796659|issn=0036-5599|pmid=17366101}}</ref> of varicocele patients have nutcracker phenomenon. If one extrapolates these numbers, between 2.9-15% of all men suffer from nutcracker phenomenon. A minuscule percentage of these patients are ever diagnosed with nutcracker phenomenon. There might be several reasons behind this under-diagnosing, including: # wide spectrum of symptoms,<ref name="Kurklinsky2010" /><ref name="Scholbach2007" /><ref name="Koshimichi2012" /><ref name="Hammami2017" /><ref name="Takahashi2000ped" /><ref name="Takahashi2000a" /><ref name="Takahashi2005" /><ref name="Takemura2000" /> many of which are not well known in the medical community to be linked to nutcracker phenomenon. # not all patients experience classic nutcracker syndrome symptoms like hematuria, abdominal pain, proteinuria<ref name="Koshimichi2012" /><ref name="Takahashi2000a" /><ref name="Takahashi2000ped" /> # diagnostic criteria are not well defined<ref name="Kurklinsky2010" /> # nutcracker phenomenon is not easily detectable using conventional means.<ref name="Matsukura2005">{{Cite journal | last = Matsukura | first = Hiro | last2 = Arai | first2 = Miwako | last3 = Miyawaki | first3 = Toshio | date = Feb 2005 | title = Nutcracker phenomenon in two siblings of a Japanese family|url=https://www.ncbi.nlm.nih.gov/pubmed/15599773|journal=Pediatric Nephrology (Berlin, Germany)|volume=20|issue=2|pages=237–238|doi=10.1007/s00467-004-1682-y|issn=0931-041X|pmid=15599773}}</ref><ref name="Kurklinsky2010" /> Standard CT is for example insufficient to diagnose nutcracker phenomenon.<ref name="Kurklinsky2010" />
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