title: Intratesticular varicoceles: are they significant?
abstract: OBJECTIVE
  Varicoceles 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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  A 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.
  
  
  CONCLUSIONS
  Our 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.
authors.affiliation: Division 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.
authors.forename: Lara S
authors.initials: LS
authors.lastname: MacLachlan
authors.forename: Shannon N
authors.initials: SN
authors.lastname: Nees
authors.forename: Angela M
authors.initials: AM
authors.lastname: Fast
authors.forename: Kenneth I
authors.initials: KI
authors.lastname: Glassberg
mesh_terms: D000293:Adolescent; D018450:Disease Progression; D006801:Humans; D008297:Male; D010173:Palpation; D012189:Retrospective Studies; D013737:Testis / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000601:surgery; D018608:Ultrasonography, Doppler; D014646:Varicocele / Q000000981:diagnostic imaging* / Q000601:surgery*; D014680:Veins / Q000000981:diagnostic imaging / Q000601:surgery