Color Doppler sonography in the intratesticular varicocele

We describe and discuss clinical and color Doppler ultrasound findings of intratesticular varicocele.

Since 1998 we evaluated 295 patients diagnosed with varicocele by scrotal color Doppler sonography Routine andrological assessment has entailed grading the varicocele (Dubin-Amelar scale and Dubin Doppler scale) and the assessment of testicular size. Intratesticular varicocele is defined as venous reflux detected into anechoic lesions of the testis with or without ypsilateral varicocele.

We detected 4 intratesticular varicoceles (1.3%), in all cases left sided with ypsilateral extratesticular varicocele. Three patients had a large varicocele, one patient had a small varicocele and bylateral testicular hypotrophy. All patients had a slight to severe worsening of sperm quality.

Intratesticular varicocele is an uncommon lesion, first described only after the color Doppler ultrasound studies have been a wide diffusion in the 1990s. A few cases are reported in literature and its incidence is unknown. Data about fertility in males with intratesticular varicocele are still anecdotic. Moreover, the knowledge of intratesticular varicocele may rule out patients for sclerotherapy procedures, or the awarness of potential gonadal damage by aetoxysclerol spread into the testis, may suggest some technical tricks. Since the simple detection of this lesion, further investigations are needed to clarify its clinical and pathophysiological significances. Color Doppler Sonography appears to be the only tool able to identify intratesticular varicocele in order to learn more about this rare condition.