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Total Testicular Volume Predicts Total Motile Count in Adolescent Varicocele Patients
Vinaya Vasudevan, M.D., Bradley A. Moganstern, M.D., Luke Griffiths, BA, Amanda Myers, M.S., Jordan S. Giltlin, M.D., F.A.C.S, F.A.A.P, Lane S. Palmer, M.D., F.A.C.S, F.A.A.P.
Cohen Children's Medical Center, Zucker/Hofstra School of Medicine, Northwell Health Systems, New Hyde Park, NY, USA.

Background: Reluctance in ordering semen analysis (SA) leads to the common use of surrogates, such as testicular asymmetry in determining indications for surgery of adolescent (AV). However, the limitations to such surrogates for SA led us to examine the correlation between changes in SA and ultrasound (US) parameters over time, and to determine whether US parameters, including total testicular volume (TTV) and testicular asymmetry could be reliably used as a surrogate for SA parameters.
Methods: All AV patients with complete ultrasound and semen analysis data after age 16 years from 2012-2017 were retrospectively reviewed. Longitudinal descriptive data (age, laterality, BMI, varicocele grade), SA data (concentration, volume, total motile count, motility), and testis size and information regarding size discrepancy were obtained. Descriptive statistics, Pearson’s correlations, independent samples T-tests, and generalized estimating equations (GEEs) were used to examine within subjects effects of age, total testicular count (TTV), and testicular asymmetry. The 2010 WHO Criteria for SA evaluation were used as a benchmark of “normal” parameters (total motile count, TMC >15 million or greater).
Results: In total, 179 subjects were included in the analysis. The mean age at initial visit/diagnosis for AV was 15.36 ± 2.10 years and mean BMI was 21.49 ± 3.49. In a binary logistic model GEE including the effects of Age and TTV on TMC, only TTV was predictive of TMC (p < 0.015). Mean TTVs overall were significantly different between patients with normal and abnormal SA (p < 0.001). TTVs for patients with abnormal and normal SAs distributed by age are presented in Table 1. In another model, TTV was predictive of motility on SA (p = 0.01). In models exploring the effects of age and TTV on sperm concentration, morphology, and total semen volume, no one factor was predictive of an abnormal sperm concentration or total semen volume.
Further models exploring the effects of testicular asymmetry and hypotrophy proved non-significant in predicting abnormal SA parameters. Pearson’s correlations examining the relationships between age and SA or ultrasound parameters identified age to exhibit a moderately positive relationship with TTV r = 0.261 (p < 0.0001), suggesting that age-related catch-up growth likely plays an important role in normalizing TMC on SA.
Conclusions: TTV may be the strongest ultrasound predictor of an abnormal TMC and motility on SA, and thus be an appropriate indication for surgical ligation of pediatric varicocele. Patients with TTV greater than 2 standard deviations below the mean for ages 16-19 should undergo repeat ultrasounds to evaluate for adequate testicular growth, as this may represent a critical period of intervention for fertility preservation.
Table 1. Total Testicular Volume
AgeNormal TMCAbnormal TMCP-value
16 - 1734.4 +/- 8.527 +/- 70.005
18 - 1935.3 +/-8.529.9 +/-9.50.003
20 - 2139.9 +/- 7.630.5 +/- 14.20.089

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