台北市立聯合醫院和平婦幼院區 泌尿科

國立陽明大學 醫學院 泌尿學科

Division of Urology, Taipei City Hospital HepingFuyou Branch, Taipei, Taiwan

Department of Urology, National Yang-Ming University School of Medicine

 

Purpose: To evaluate the incidence and effect of intratesticular varicocele in patients with varicocele or subclinical varicocele.

Materials and methods: Intratesticular varicocele is a clinically occult lesion that may occur in patients with extratesticular varicocele and first described in 1992 by Weiss et al. The diagnosis is based on an anechoic lesion radiating from the mediastinum testis into the testicular parenchyma and color Doppler ultrasound (CDU) showed increased venous flow during Valsalva maneuver. The incidence is about 1.7% in 1040 men undergoing scrotal ultrasound by Das et al, but its role and effect for men is not clear, and the association with varicocele or subclinical varicocele in still under investigation. 100 men with varicocele (group 1), 60 men with subclinical varicocele (group 2), and 20 age-matched men without varicocele or subclinical varicocele (group 3) were recruited. The patients were examined in a warm room while standing up. The scrotum of each patient was inspected and palpated. The diagnosis of subclinical varicocele was a non-palpable vein with retrograde reflux under Valsalva maneuver by CDU. The diagnosis of intratesticular varicocele was retrograde reflux within testis under Valsalva maneuver by CDU. The parameters for evaluation and comparison included age, body mass index (BMI), semen quality (sperm motility, morphology, and density), testicular volume, peak retrograde flow (PRF), and maximal vein diameter (MVD), testicular blood flow and resistive index.

Results: The mean ages of the patients in Groups 1, 2, and 3 were 34.7, 35.2, and 34.9 years, respectively. The incidence of intratesticular varicocele is higher in patients with varicocele (9%) than those with subclinical varicocele (3.3%) or normal control (0%). The incidence of male subfertility was 21%, 10% and 0% in groups 1, 2, and 3, respectively. Of 21 subfertile patients in group 1, 3 had intratesticular varicocele, and of 2 subfertile patients in group 2, 1 had intratesticular varicocele. Varicocele patients associated with ipsilateral intratesticular varicocele have significantly higher PRF than those without (34.1 ± 3.5 vs. 31.8 ± 2.7 cm per second). There was no significant difference for resistive index and testicular blood flow between patients with and without intratesticular varicocele in group 1 or 2 patients.

Conclusion: The role of intratesticular varicocele in patients with varicocele or subclinical varicocele is unclear. Varicocele patients associated with intratesticular varicocele had higher incidence of male subfertility than those without, but the case number is relatively small in this study.