Ultrasound maximum vein diameter contextualizes testicular asymmetry in adolescent varicocele

To characterize the clinical patterns linking ultrasound-measured maximum vein diameter (MVD), testicular asymmetry, and short-term trajectories in adolescents with varicocele, with emphasis on the natural course of asymmetry and postoperative outcomes.

We retrospectively reviewed adolescents diagnosed with varicocele between 2010 and 2025. Baseline evaluation included testicular volumes, MVD, and color Doppler reflux characteristics. Management was conservative or surgical based on clinical indications. The primary outcomes were baseline testicular asymmetry and its resolution (catch-up growth) during follow-up. Prespecified secondary outcomes included postoperative pain status, hydrocele development and its time course, epididymal cysts, and testicular microlithiasis.

Across distinct within-cohort analyses, MVD was associated with asymmetry trajectories. In adolescents who underwent surgery for asymmetry, an exploratory ROC-derived threshold (approximately MVD ≥ 3.5 mm) indicated a higher likelihood of postoperative catch-up growth. Conversely, among adolescents with baseline asymmetry managed conservatively, MVD < 3.5 mm was more frequently observed in those whose asymmetry resolved without surgery, whereas higher MVD values were associated with persistence. Most symptomatic patients improved postoperatively; however, persistent pain was not predicted by preoperative MVD or Doppler reflux status. Hydrocele occurred predominantly in the first postoperative year and declined thereafter, without an evident impact on catch-up growth. Epididymal cysts were more frequently identified postoperatively, while the prevalence of testicular microlithiasis remained stable throughout the follow-up period.

MVD is a practical adjunct that may help contextualize asymmetry and inform surveillance versus intervention; in our cohort, an exploratory threshold of  ~ 3.5 mm differentiated asymmetry trajectories within operative and non-operative subgroups. Postoperative epididymal cysts were more frequently detected, and testicular microlithiasis prevalence remained stable, warranting further study.