Does Total Testicular Volume Predict Testicular Volume Difference in Adolescent Males with Varicocele?
Beth Drzewiecki, M.D., Ari Bernstein, B.A., Ethan Fram, M.D., Amanda North, M.D., Anthony Casale, M.D..
Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
Adolescent varicoceles continue to post a great challenge to pediatric urologists. The dilemma of over-aggressive treatment has proven difficult to balance with the risk of infertility. We hoped that elucidating the relationship between total testicular volume (TTV) and testicular volume difference (TVD) could be useful in identifying patients who are at greater risk for infertility while decreasing the need for more invasive testing, such as semen analysis, in an adolescent population. We evaluated the relationship between TTV and TVD in adolescent males with varicocele. Both low TTV and high TVD have been associated with higher incidences of infertility later in life, but a predictive relationship between TTV and TVD directly has yet to be described.
We retrospectively analyzed a database of Tanner 5 boys ages 16-21 who presented with varicocele at a single institution between 2009 and 2017. Inclusion criteria was a scrotal sonogram prior to surgical intervention. TTV and TVD were calculated for each individual and four non-exclusive groupings of patients were created for statistical analysis.
209 patients met our inclusion criteria. Mean age was 18.3 years old (16-21, SD 1.7) with a mean total testicular volume of 36cc (13.5-78.2, SD 11.1). The majority of patients had either a left-sided (66%) or bilateral (31%) varicoceles, with a minority of patients having a right-sided varicocele (3.3%). Cut off points of TVD of 20% and TTV of 30cc were used to separate patients. There were 65 boys (31%) with TTV < 30cc and 58 boys (28%) with TVD ≥ 20%. Among the males with TTV < 30cc, 23 (35%) had a TVD ≥ 20%. Among the males with TTV ≥ 30cc, 35 (24%) had a TVD ≥ 20%. The relationship between TVD and TTV was found to be non-significant (p > 0.05).
In our population, there was a non-significant relationship between TTV < 30cc and TVD ≥ 20% (p > 0.05). Low TTV (< 30cc) itself is not predictive of high TVD (≥ 20%) in adolescent boys with varicocele despite their reported independent associations with impaired fertility in other studies.
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