In 27 patients with clinically identified idiopathic left varicocele, a retrograde venography and a combined pressure measurement in the vena cava, vena renalis and vena spermatica was performed. During Valsalva maneuver the pressure values increased. We could not confirm increased pressure values in the left renal vein dependent on the patient's position. There were no increasing pressure gradients between vena renalis and vena cava in erect position. Therefore an elevated pressure in the left renal vein and especially the 'upper nutcracker' does seem to be of at least limited importance for the pathogenesis of idiopathic varicocele.
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