Intratesticular Varicocele Research Articles

Microsurgical varicocelectomy for intratesticular varicocele with a history of orchiopexy for undescended testis

IntroductionWe report a case series of six patients with a chief complaint of infertility who underwent microsurgical varicocelectomy for intratesticular varicocele (ITV) after undergoing orchiopexy for undescended testis in their childhood.Case presentationThe patients' median age was 34 years. The median age at which orchiopexy was performed was 4.5 years. All the cases of ITV were accompanied by extratesticular varicocele (ETV). All the patients underwent a microsurgical subinguinal varicocelectomy. At 3 months after operation, the ITV and ETV had disappeared in all the cases. Sperm density and motility increased in five and four patients, respectively.ConclusionITV occurs at a relatively high frequency after orchiopexy for undescended testis. Disorder of the valvular function of the testicular vein in peeling the testicular vessels was thought to be a primary cause and is often found on the left side. Doppler ultrasonography of the testis is considered important for diagnosis.

Intratesticular and extratesticular varicocele: Ultrasound and doppler appearance

Extratesticular varicocele is a commonly encountered condition affecting young male adults. Intratesticular varicocele is a rare entity seen invariably in association with extratesticular variety. Characteristic appearances on B-mode and Doppler ultrasound evaluation help in confirming the diagnosis. We present a case of a 17-year-old male who complains of scrotal swelling and dull-aching left testicular pain for 3 months. Ultrasound and Doppler evaluation was performed which aided in confirmation of diagnosis.

Intratesticular varicocele: a rare cause of male factor infertility

A 27-year-old man who presented to the urology outpatient department of our hospital with primary infertility was referred for scrotal ultrasonography (USG). He had no scrotal pain, prior sexually transmitted...

Thrombotic and Nonthrombotic Types of Intratesticular Varicoceles: Value of Sonography for the Diagnosis.

An intratesticular varicocele is an uncommon entity, and its clinical importance remains unclear. The diagnosis can be made in the case of an intratesticular tortuous vein that shows retrograde flow on color Doppler sonography. The anatomic location and course of the intratesticular varicocele within the testicular parenchyma and its association with the existence of an ipsilateral extratesticular varicocele may vary among patients. The pathophysiologic mechanisms remain unclear; however, it may be questioned whether there is an association between testicular atrophy and intratesticular varicocele development. Although the diagnosis is usually made incidentally, patients may rarely present with acute scrotal pain due to acute thrombosis of an intratesticular varicocele.

Tubular Ectasia of Rete Testis with Spermatocele.

A 55-year-old male patient presented with a slowly enlarging, painless, large soft mass lesion in left scrotal sac for 6 month. On clinical examination the mass lesion could not be separated from testis, hence provisional diagnosis of testicular tumour was made. For further evaluation scrotal ultrasound was performed. In the region of the clinically palpable lump, ultrasound revealed a unilocular, well-circumscribed cystic lesion with moderately thick wall and fine internal echoes [Table/Fig-1]. The size of lesion was approximately 4.5 x 5 cm. It was located cranial to testis, partially replacing left epididymis. No internal or peripheral flow was detected on colour Doppler study. Mild fluid was also noted in scrotal sac, which was consistent with hydrocele. Right testis and epididymis were normal. [Table/Fig-1]: Gray scale ultrasound image of left scrotal sac shows a well circumscribed, rounded, unilocular cystic lesion with low level internal echoes located superior to left testis consistent with the diagnosis of spermatocele Ultrasound examination also revealed a cluster of multiple, small, anechoic cysts located in the region of testicular mediastinum [Table/Fig-2]. No solid component or calcification was seen. No evidence of any obvious arterial or venous flow was noted in the cysts on colour Doppler study [Table/Fig-3]. [Table/Fig-2]: Transverse (A), longitudinal (B) gray scale ultrasound images of left testis shows a cluster of multiple small anechoic cystic structures noted in the region of testicular mediastinum with hydrocele [Table/Fig-3]: Transverse colour Doppler ultrasound image of left testis shows numerous small cysts with no colour flow On the basis of characteristic ultrasound and Doppler findings final diagnosis was made of tubular ectasia of rete testis and spermatocele. Because of benign nature of this condition patient was reassured and ask for 6 monthly follow up. Tubular ectasia of the rete testis is a benign clinical entity in which cystic dilation of rete testis results from partial or complete obliteration of the efferent ducts [1]. The obstruction may occur at different levels and may be classified into intra- or extra-testicular. In testicular lesions, the obstruction generally resulting from previous inflammatory episodes like orchitis, while in extra-testicular lesions, traumatic tearing of epididymis, obstruction from epididymitis, spermatoceles and tunica albuginea cyst and post-vasectomy or other scrotal surgeries are the common causes [2]. Typically this condition affects patients older than 50 year of age. Bilateral lesions have been reported in 29 to 69% of cases [3]. Spermatocele and epididymis cysts are commonly associated with this condition. Ultrasonography is usually the first and only modality needed to diagnose this condition. Sonographic findings of tubular ectasia of rete testis consists of a cluster of several anechoic rounded and serpiginous tubular structures located in the mediastinum testis without any solid areas or calcific foci. They do not cause mass effect on the adjacent testicular parenchyma. Colour Doppler shows no arterial or venous flow within cystic lesions [4]. Spermatoceles are common extra-testicular lesions caused by cystic dilation of efferent ductules in the region of head of epididymis. On ultrasonography, it appears as a unilocular or multilocular hypoechoic cystic lesion located superior to and separate from testis. It is usually small in size ranging from 1-2cm in size. However large lesions upto 8 cm in size have been reported in the literature [5]. Spermatocele may show low-level echogenic internal echoes due to proteinaceous fluid containing dead sperms. MRI is usually not indicated because of typical appearance on ultrasound. However, if done in doubtful cases, reveals a cluster of round or serpiginous lesions in the hilum of testis, which appear hypointense TI-weighted and hyperintense on T2- weighted images. The main differential diagnosis includes intra-testicular varicocele and cystic dysplasia of testis. Intra-testicular varicocele is a rare entity, which can give similar appearance on B-mode ultrasonography, however colour Doppler and pulsed Doppler evaluation shows colour flow with characteristic venous spectral waveform that augments during Valsalva maneuver [6]. Cystic dysplasia of testis is thought to be a congenital condition unlike tubular ectasia of rete testis which is an acquired condition. It is seen in children and has similar appearance to tubular ectasia of rete testis [7]. Other differential diagnosis includes epididymal cystadenoma, teratoma, non-Hodgkin’s lymphoma and seminiferous tubules dilatation secondary to testicular neoplasms [1]. Tubular ectasia of rete testis and spermatocele are benign entities With characteristics features on gray scale and colour Doppler examination. This condition should be recognized in older individuals and its awareness can prevent unnecessary investigations and surgical intervention.

Intratesticular varicoceles: Are they significant?

ObjectiveVaricoceles occur in 15% of adult and adolescent males and are generally considered to be an extratesticular phenomenon. However, an intratesticular component has been reported in up to 2% of adult and 2% of adolescent varicoceles. We sought to determine the incidence of intratesticular varicoceles (ITV) in adolescents in our practice, its significance, associated findings and response to treatment. Materials and methodsWe retrospectively reviewed 684 adolescent males who were diagnosed with varicoceles and had at least one Doppler ultrasound (DUS) prior to any surgery to identify those with an intratesticular component. Testicular volumes, maximum vein diameter (MVD) and peak retrograde flow (PRF) were determined by DUS and recorded. ResultsA total of 6 (0.9%) patients were found to have an intratesticular component with a mean PRF of 43.7 cm/s, mean MVD of 3.3 mm and mean asymmetry of 20%. Mean PRF, MVD, and asymmetry of those without an intratesticular component who underwent surgery was 44.8 cm/s, 2.9 mm, and 21.8%, respectively (PNS for all parameters). Four of the 6 patients had 2 or more DUS, and all 4 had worsening testicular asymmetry and PRF over time. Five patients underwent laparoscopic varicocelectomy and all five had catch-up testicular growth. One patient refused surgical repair and has had subsequent worsening testicular asymmetry and softening of the testicle. ConclusionsOur findings suggest that adolescents who present with an intratesticular varicocele in association with testicular asymmetry will develop worse asymmetry over time. Therefore, adolescents with intratesticular varicoceles and initial asymmetry should be scheduled for surgery rather than followed.

Ultrasonography of tubular ectasia of the rete testis with associated scrotal findings.

Tubular ectasia of the rete testis (TERT) is a rare disorder that can be seen on ultrasonography (US) during a routine examination. In this study, we aim to discuss 15 cases of TERT and concomitant scrotal pathologies. A total of 405 patients who were admitted to our department between March 2009 and December 2011 for scrotal US with different complaints such as scrotal pain, palpable mass, infertility, varicocele, or hydrocele were evaluated. Presence or absence of TERT and associated scrotal anomalies if TERT was present were considered on gray-scale US and color Doppler US. Tubular ectasia of the rete testis was detected in 15 patients (3.7%). It was unilateral in eleven patients (73.3%) and bilateral in four patients (26.7%). The mean age of the patients with TERT in this study was 43.7years (range 24-85years). Five patients (33.3%) with TERT presented with infertility, four of them (26.7%) presented with palpable mass, and six of them (40%) were admitted with scrotal pain. In 14 patients (93.3%), at least oneof the following disorders associated with TERT was seen: epididymal cyst, spermatocele, hydrocele, and varicocele. Tubular ectasia of the rete testis shows characteristic appearances on gray-scale and Doppler US evaluation, and no other modality is necessary for diagnosis. TERT is usually associated with epididymal pathologies such as epididymal cyst or spermatocele located on the same side. Testicular neoplasms, intratesticular varicocele, and cystic dysplasia of the testis should be considered in the differential diagnosis of TERT.

High prevalence of intratesticular varicocele in a post-orchidopexy cohort

PurposeIntratesticular varicocele (ITV) is an uncommon sonographic finding. A prevalence of up to 2% has been reported in men with testicular problems. In a cohort of men who had undergone prepubertal orchidopexy for acquired undescended testis, several cases of ITV were found. The aim of this study was to analyse the prevalence and clinical aspects of ITV in this cohort. MethodsIn a long-term follow-up study of position and growth of undescended testis after prepubertal orchidopexy, ultrasonography was used to identify men with ITV. Data on clinical presentation, testicular volume, and the location, size and Doppler aspects of intratesticular varicocele were collected and analysed. ResultsOf the 105 men, 9 were identified with ITV (8.6%). In all patients, the side of orchidopexy correlated with the side of the ITV, and all were left-sided. The testis with ITV had a smaller volume than the testis without ITV (p = 0.026). ConclusionsA remarkably high prevalence of ITV (8.6%) was found as well as a smaller volume of the testes with ITV in a cohort of men who had undergone prepubertal orchidopexy for acquired undescended testis.

Intratesticular varicocele

We report case of a 28-year-old male who had extratesticular varicocele which was associated with intratesticular varicocele. The patient was referred to our department with pain in scrotal region. Routine scrotal sonography revealed extratesticular varicocele which was confirmed by color Doppler. It was associated with intratesticular varicocele. Intratesticular varicocele is a rare condition with a variable sonographic appearance. Color Doppler sonography is helpful in confirming the diagnosis. Detection of intratesticular component is essential in the management of varicoceles.

Bilateral Intratesticular and Extratesticular Varicoceles Secondary to Extensive Inferior Vena Cava Thrombosis

Intratesticular varicoceles are relatively rare findings with unknown clinical implications. 1 Gray scale and color Doppler sonography can confirm the diagnosis, showing findings similar to those of the more commonly identified extratesticular varicoceles. We present a case of bilateral intratesticular and extratesticular varicoceles secondary to congenital interruption of the inferior vena cava (IVC) with azygos/hemiazygos continuation. To our knowledge, there is no other reported case in the literature.

1432: Color Doppler Ultrasound Findings of Intratesticular Varicocele

ObjectiveTo study the appearances of the color Doppler ultrasound (CDU) in intratesticular varicocele (ITV) and its pathogenesis and value of clinical application.MethodsA period of three years, 3098 patients with various scrotal diseases were examined by CDU with 10∼14 MHz linear array transductor, analyzed emphatically the appearances of the CDU in ITV, with reviewed the literature.ResultsITV was identified in 1.0% (31/3098) patients with various scrotal diseases, in 2.7% (31/1167) with extratesticular varicocele, and in 8.1%(15/185)with grade III extratesticular varicocele. Of 31 cases, 25 were located in the left testis, 5 in the right, and 1 bilateral. The locations of the ITVs were within the testicular parenchyma in 21, subcapsular in 6, within the mediastinum in 1, mixable in 4. The shapes of the ITVs were serpentine in 15, tubular in 12, oval in 1, and mixable in 4. Diameter ranged from 0.9 to 5.2 mm (mean, 1.6 mm). On CDU, spontaneous retrograde flow was showed in 5 and the retrograde flow could be seen only after the Valsalva maneuver in 27. According to the varication extent of the intratesticular veins, the findings were graded as I∼III stages. The inverse flows of the ITVs were all from ipsilateral pampiniform plexus.ConclusionsITV has a characteristic CDU appearance. With extratesticular varicocele, the rise of the hydrostatic pressure in the pampiniform plexus could not directly result in ipsilateral ITV. The presence of the ITV in extratesticular varicocele may further impair spermatogenesis. ObjectiveTo study the appearances of the color Doppler ultrasound (CDU) in intratesticular varicocele (ITV) and its pathogenesis and value of clinical application. To study the appearances of the color Doppler ultrasound (CDU) in intratesticular varicocele (ITV) and its pathogenesis and value of clinical application. MethodsA period of three years, 3098 patients with various scrotal diseases were examined by CDU with 10∼14 MHz linear array transductor, analyzed emphatically the appearances of the CDU in ITV, with reviewed the literature. A period of three years, 3098 patients with various scrotal diseases were examined by CDU with 10∼14 MHz linear array transductor, analyzed emphatically the appearances of the CDU in ITV, with reviewed the literature. ResultsITV was identified in 1.0% (31/3098) patients with various scrotal diseases, in 2.7% (31/1167) with extratesticular varicocele, and in 8.1%(15/185)with grade III extratesticular varicocele. Of 31 cases, 25 were located in the left testis, 5 in the right, and 1 bilateral. The locations of the ITVs were within the testicular parenchyma in 21, subcapsular in 6, within the mediastinum in 1, mixable in 4. The shapes of the ITVs were serpentine in 15, tubular in 12, oval in 1, and mixable in 4. Diameter ranged from 0.9 to 5.2 mm (mean, 1.6 mm). On CDU, spontaneous retrograde flow was showed in 5 and the retrograde flow could be seen only after the Valsalva maneuver in 27. According to the varication extent of the intratesticular veins, the findings were graded as I∼III stages. The inverse flows of the ITVs were all from ipsilateral pampiniform plexus. ITV was identified in 1.0% (31/3098) patients with various scrotal diseases, in 2.7% (31/1167) with extratesticular varicocele, and in 8.1%(15/185)with grade III extratesticular varicocele. Of 31 cases, 25 were located in the left testis, 5 in the right, and 1 bilateral. The locations of the ITVs were within the testicular parenchyma in 21, subcapsular in 6, within the mediastinum in 1, mixable in 4. The shapes of the ITVs were serpentine in 15, tubular in 12, oval in 1, and mixable in 4. Diameter ranged from 0.9 to 5.2 mm (mean, 1.6 mm). On CDU, spontaneous retrograde flow was showed in 5 and the retrograde flow could be seen only after the Valsalva maneuver in 27. According to the varication extent of the intratesticular veins, the findings were graded as I∼III stages. The inverse flows of the ITVs were all from ipsilateral pampiniform plexus. ConclusionsITV has a characteristic CDU appearance. With extratesticular varicocele, the rise of the hydrostatic pressure in the pampiniform plexus could not directly result in ipsilateral ITV. The presence of the ITV in extratesticular varicocele may further impair spermatogenesis. ITV has a characteristic CDU appearance. With extratesticular varicocele, the rise of the hydrostatic pressure in the pampiniform plexus could not directly result in ipsilateral ITV. The presence of the ITV in extratesticular varicocele may further impair spermatogenesis.

Intratesticular Varicocele Associated with Ipsilateral Extratesticular Varicocele

Jeong Man Cho, Kyong Tae Moon, Hyun Seung Kim, Jeong Yoon Kang, Tag Keun Yoo, Seung Wook Lee From the Department of Urology, Eulji University School of Medicine, Seoul, Korea Intratesticular varicocele is a rare entity and refers to a dilated intratesticular vein radiating from the mediastinum testis into the testicular parenchyma. A 22-year-old man was admitted to our hospital with left testicular pain. On physical examination, a grade III varicocele was noted on the left side. Gray-scale ultrasound and color Doppler ultrasound examinations revealed intratesticular and extratesticular varicocele. The patient underwent spermatic vein ligation by open modified Palomo varicocelectomy. (Korean J Urol 2009;50:822-824) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Non neoplastic intratesticular masses

The use of high-frequency ultrasound is increasing for the treatment of cystic, vascular, and solid non-neoplastic intratesticular masses. Cystic lesions examined include simple testicular cysts, tunica albuginea cysts, epidermoid cysts, tubular ectasia of rete testis, and intratesticular abscesses. Vascular lesions examined include intratesticular varicocele and intratesticular arteriovenous malformations. Solid lesions examined include fibrous pseudotumor of the testis, focal or segmental testicular infarct, fibrosis of the testis, testicular hematoma, congenital testicular adrenal rests, tuberculoma, and sarcoidosis. Gray-scale and color-flow Doppler sonography facilitate the visualization of the benign characteristics of the lesions. Magnetic resonance imaging can also help as a problem-solving modality in some cases.

Intratesticular Varicocele

Intratesticular varicocele (ITV) is an uncommon sonographic finding with controversial data concerning its prevalence and physiopathologic characteristics. The goal of this study was to determine the prevalence of ITV in a urogenital imaging department and to describe its sonographic features. All identified cases of ITV were prospectively collected in the same imaging department. Intratesticular dilated veins (>2 mm) with a positive response to the Valsalva maneuver were referred to as ITV. Nine cases of ITV were detected in 8 patients (mean age, 60 years; range, 30-85 years) in a series of 1832 scrotal sonographic examinations performed over 5 years (0.4%). A history of homolateral scrotal surgery was found in 5 cases. In most cases, ITV was left sided (6/9) and located in the mediastinum testis (6/9) with associated extratesticular varicocele (8/9) and testicular hypotrophy (7/9). Five of the 7 hypotrophic testes had other causes of hypotrophy. Although variations do exist in the sonographic appearance of ITV, its specific sonographic and Doppler appearance should enable the radiologist to obviate further study. Intratesticular varicocele is often associated with ipsilateral testicular atrophy, but whether it is a cause or a consequence of testicular atrophy remains unclear.

Intratesticular varicocele: evaluation using grey scale and color Doppler ultrasound

Intratesticular varicocele is a rare condition with a variable clinical and ultrasound presentation. The purpose of this study was to evaluate the grey scale and color Doppler appearances of intratesticular varicocele (ITV). Herein we present seven new cases of intratesticular varicocele. From 2003 to 2005 we evaluated 342 patients referred to our department for routine andrological evaluation by scrotal color Doppler ultrasound. We detected seven entirely asymptomatic cases of ITV by use of grey scale ultrasound. In color Doppler sonography the patients showed retrograde blood flow, either spontaneously or during Valsalva manoeuvre. In all seven cases left side ITV with testicular volume disproportion between the right and left testis (2 ml) was found. Five patients had an extratesticular varicocele. In all patients the diameters of intratesticular vein were less than 2 mm. Intratesticular varicocele is a clinically occult lesion that may occur in association with extratesticular varicocele. Further investigations are needed to clarify its clinical significance, however, considering the temperature mediated damage on the affected testis, it is our opinion that all ITV must be considered for treatment even if an extratesticular varicocele is not present.

Varicocele intratesticular asociado a atrofia glandular y a alteraciones ecográficas parenquimatosas

To report one case of intratesticular varicocele, infrequent pathology (2% of the cases), with a series of ultrasound peculiarities: testicular atrophy and associated parenchymal abnormalities, in a 24-year-old patient with left testicular pain. Ultrasound showed severe left varicocele, mixed type, with the regular extratesticular component and dilated subcapsular and mediastinum vessels, with turbulent flows increasing with Valsalva's manoeuvre, as well as an alteration of the ultrasound pattern of the parenchyma, with hypoechoic and hypovascular areas and diminished testicular size. Intratesticular varicocele is a rare pathology more frequent in the left testicle, which is frequently associated with extratesticular varicocele. The presence of testicular atrophy and associated parenchymal abnormalities has been rarely described in the literature. Clinically they show features overlapping the extratesticular types.

Sonography of Benign Intrascrotal Lesions

Ultrasound plays an important role and adds essential information in diagnosing benign intrascrotal lesions. Characterization of benign intrascrotal lesions with sonography, in combination with clinical assessment, can lead to nonsurgical management or testicular sparing surgery. We present important sonographic features of benign intrascrotal lesions, including extratesticular lesions: adenomatoid tumors, papillary cystadenomas, spermatoceles, hydroceles, varicoceles, hernias; and intratesticular lesions: tunica albuginea cysts, testicular simple cysts, epidermoid cysts, tubular ectasia of the rete testis, intratesticular varicoceles, adrenal rest tumors, and splenogonadal fusion. The goal of this review is to provide the radiologist with a better understanding of benign lesions that occur in the scrotum.

Intratesticular varicocele and extratesticular varicocele in a patient with nephrotic syndrome complicated by left renal vein thrombosis

Intratesticular varicocele and extratesticular varicocele in a patient with nephrotic syndrome complicated by left renal vein thrombosis

Ultrasound Findings of an Intratesticular Varicocele. Report of a New Case and Review of the Literature

The authors present a new case of intratesticular varicocele(ITV). The ultrasound findings on gray-scale and color Doppler imaging as well as the pertinent clinical manifestations are discussed. A review of the literature is also presented. According to our knowledge only 34 cases of ITV have been reported in the literature and the clinical significance of this lesion is not yet well established. This is the first reported case of infertility caused by a solely ITV, showing that the clinical implications of this entity may be more significant than previously thought.

Intratesticular Varicocele

The purpose of this study was to evaluate the gray scale and color Doppler appearances of intratesticular varicocele (ITV) in a relatively large series of men and to compare the findings with those previously reported. Fifteen ITVs found in 12 men referred for sonographic examination of a variety of scrotal conditions were retrospectively evaluated. Review of the side, location, shape, and diameter of the dilated veins, the presence of an extratesticular varicocele (ETV), and the color Doppler appearance of the ITV before and during the Valsalva maneuver was performed. Seven (47%) of 15 ITVs were located in the left testis, 2 (13%) in the right, and 3 (20%) bilateral. Eighty-six percent of the ITVs were associated with an ipsilateral ETV. The locations of the ITVs were subcapsular in 60% of the cases and within or near the mediastinum of the testis in 40%. The shapes of the ITVs were tubular in 46%, oval in 27%, and both tubular and oval in the remaining 27%. Color Doppler imaging showed spontaneous flow in 60% of cases, whereas in the remaining 40%, the blood flow could be seen only after the Valsalva maneuver. Intratesticular varicocele is a rare condition with a variable clinical and sonographic appearance. It is usually associated with ETV. It occurs in the left, right, or both testes and may be subcapsular or mediastinal in location. The prevalence of a subcapsular location of ITVs in this series was by far higher than previously mentioned in the literature. The Valsalva maneuver plays a very important role in the diagnosis of ITV because in almost half of cases, the flow will not show up spontaneously.