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Intratesticular varicoceles: are they significant?

Lara S MacLachlan¹, Shannon N Nees, Angela M Fast

¹Division of Pediatric Urology, Morgan-Stanley Children's Hospital of New York-Presbyterian, Department of Urology, Columbia University College of Physicians and Surgeons, 3959 Broadway, CHN 1118, New York, NY 10032, USA.

Journal of Pediatric Urology

|December 11, 2012

Summary

Intratesticular varicoceles (ITV) in adolescents are rare but associated with worsening testicular asymmetry. Early surgical intervention for ITV with asymmetry is recommended over observation to improve testicular growth.

Keywords:

DUS Doppler ultrasound ETV ITV Intratesticular varicocele MVD PRF Testicular asymmetry Varicocele extratesticular varicocele intratesticular varicocele maximum vein diameter peak retrograde flow

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Area of Science:

Urology
Pediatric Surgery
Diagnostic Imaging

Background:

Varicoceles affect 15% of males, typically considered extratesticular.
An intratesticular component (ITV) is found in up to 2% of varicoceles.
The significance of ITV in adolescents requires further investigation.

Purpose of the Study:

To determine the incidence of intratesticular varicoceles (ITV) in adolescents.
To assess the significance, associated findings, and treatment response of ITV in this population.
To evaluate the impact of ITV on testicular asymmetry and growth.

Main Methods:

Retrospective review of 684 adolescent males with varicoceles.
Identification of intratesticular components using Doppler ultrasound (DUS).
Analysis of testicular volumes, maximum vein diameter (MVD), and peak retrograde flow (PRF).

Main Results:

Six patients (0.9%) presented with intratesticular varicoceles.
Patients with ITV showed worsening testicular asymmetry and PRF over time.
Five of six patients undergoing varicocelectomy experienced catch-up testicular growth.

Conclusions:

Adolescents with intratesticular varicoceles and testicular asymmetry experience progressive asymmetry.
Surgical repair is recommended for adolescents with ITV and initial asymmetry.
Early intervention may prevent further testicular growth impairment.