Total Testicular Volume and Testicular Volume Discrepancy in the Assessment of Male Fertility Potential in Adolescent Varicocele
Adele Raymo, BS1, Maria Camila Suarez, MD2, Maxwell Towe, MD2, Samantha Isern, MD1, Daniel E. Nassau, MD1, Rafael Gosalbez, MD1, Miguel Castellan, MD1, Andrew Labbie, MD1, Ranjith Ramasamy, MD2, Alireza Alam, MD1.
1Nicklaus Children's Hospital, Miami, FL, USA, 2University of Miami, Miami, FL, USA.
BACKGROUND: Adolescent varicocelectomy is recommended when either an abnormal semen analysis (SA) or testicular volume discrepancy (TVD) ≥20% is present. However, TVD may occur in the healthy pediatric population. We hypothesized that lower than expected ultrasonographic TVD and total testicular volume (TTV) are indicative of poor semen parameters in adolescents with varicocele.
METHODS: We retrospectively identified by diagnosis-codes boys <21 years with left varicocele from 2013-2022. Inclusion criteria were Tanner stage of ≥3, and having a SA and ultrasound prior to surgery. Semen parameters and clinical variables were compared among patients with ≥20%TVD to those with <20%TVD. For Tanner 5 patients, the total motile sperm count (TMSC) was compared between patients with TTV≥30cc (normal cutoff for post-pubertal patients) and TTV<30cc. Comparison among groups was assessed by unpaired t-test and Chi-square test (p<.05).
RESULTS: A total of 127 patients were included in the study. The mean age at the time of the SA was 17.3 years (range of 14- 21). TVD<20% was observed in 86 patients and TVD≥20% in 41 patients. TVD was not associated with any of the analyzed variables (table 1). Of 81 tanner 5 patients, 23 (28.4%) had TTV≥30cc and 58 (71.6%) had TTV<30cc. The mean TMSC and TVD for Tanner 5 boys with TTV≥30cc was 132.6±176.6 million and 13.3±9.3%, compared to 57.5±73.9 million and 18.3±12.7% for boys with TTV<30cc (p=.03 and p=.03, respectively).
CONCLUSIONS: In this cohort of pediatric patients with varicocele, TVD was not associated with any of the analyzed variables. However, in Tanner 5 patients, TTV<30cc was associated with low TMSC and high TVD. We therefore recommend considering TTV as an indicator of testicular growth arrest in Tanner 5 adolescents with varicocele.
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