Intratesticular varicocele is a rare entity, occurring in ~2% of symptomatic population.
It is defined as dilated intratesticular veins seen in relation to the mediastinum testis and extending peripherally. It is usually seen in the presence of ipsilateral extratesticular varicocele.
Most of the reported cases of intratesticular varicocele occur on the left side as is the case with extratesticular varicocele. The testicular pain is attributed to the stretching of the tunica albuginea after active and passive congestion and dilatation of veins 1.
Increased incidence is noted in men who had undergone prepubertal orchidopexy for acquired undescended testis 2.
Ultrasound with color Doppler is the investigation of choice for diagnosis of intratesticular varicoceles. The three commonly recognisable patterns of intratesticular varicocele on ultrasound studies are:
- tubular (most common)
ectasia of rete testis: usually resembles intratesticular varicocele
- the presence of color flow within the anechoic lesions confirms intratesticular varicocele
testicular cysts: usually well-defined and anechoic with enhanced through transmission and an imperceptible wall
- presence of color flow in an intratesticular varicocele is the main differentiating feature
- 1. Das KM, Prasad K, Szmigielski W et-al. Intratesticular varicocele: evaluation using conventional and Doppler sonography. AJR Am J Roentgenol. 1999;173 (4): 1079-83. doi:10.2214/ajr.173.4.10511183 - Pubmed citation
- 2. Meij-de Vries A, den Bakker FM, van der Wolf-de Lijster FS et-al. High prevalence of intratesticular varicocele in a post-orchidopexy cohort. J Pediatr Urol. 2013;9 (3): 328-33. doi:10.1016/j.jpurol.2012.04.004 - Pubmed citation