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Glick H, Claflin J, Heximer A, Fiestan GO, Varon D, Daignault-Newton S, Van Til M, Wan J, Kraft KH. Testicular catch-up growth in the non-operative management of the adolescent varicocele. J Pediatr Urol 2023; 19:652.e1-652.e6. [PMID: 37394305 DOI: 10.1016/j.jpurol.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/05/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION Adolescent varicocele is a common urologic condition with a spectrum of outcomes, leading to variations in management. Testicular hypotrophy is a common indication for surgery Routine monitoring may be an appropriate form of management for many adolescents with testicular hypotrophy, as studies have shown that a large proportion of these patients may experience catch-up growth of the ipsilateral testis. Furthermore, there are few longitudinal studies which have correlated patient specific factors to catch-up growth. We aimed to determine the frequency of testicular catch up-growth in adolescents with varicocele while also examining if patient specific factors such as BMI, BMI percentile, or height correlated with testicular catch-up growth. METHODS A retrospective chart review found adolescent patients who presented to our institution with varicocele from 1997 to 2019. Patients between the ages of 9 and 20 years with left-sided varicocele, a clinically significant testicular size discrepancy, and at least two scrotal ultrasounds at least one year apart were included in analysis. Testicular size discrepancy of greater than 15% on scrotal ultrasound was considered clinically significant. Testicular size was estimated in volume (mL) via the Lambert formula. Statistical relationships between testicular volume differential and height, body mass index (BMI), and age were described with Spearman correlation coefficients (ρ). RESULTS 40 patients had a testicular volume differential of greater than 15% at some point during their clinical course and were managed non-operatively with observation and serial testicular ultrasounds. On follow-up ultrasound, 32/40 (80%) had a testicular volume differential of less than 15%, with a mean age of catch up growth at 15 years (SD 1.6, range 11-18 years). There were no significant correlations between baseline testicular volume differential and baseline BMI (ρ = 0.00, 95% CI [-0.32, 0.32]), baseline BMI percentile (ρ = 0.03, 95% CI [-0.30, 0.34]), or change in height over time (ρ = 0.05, 95% CI [-0.36, 0.44]). DISCUSSION The majority of adolescents with varicocele and testicular hypotrophy exhibited catch-up growth with observation, suggesting that surveillance is an appropriate form of management in many adolescents. These findings are consistent with previous studies and further indicate the importance of observation for the adolescent varicocele. Further research is warranted to determine patient specific factors that correlate with testicular volume differential and catch up growth in the adolescent varicocele.
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Affiliation(s)
- Hannah Glick
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Jake Claflin
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Alisha Heximer
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | | | - David Varon
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | | | - Monica Van Til
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Julian Wan
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Kate H Kraft
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.
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Hung JWS, Chung KLY, Yam FSD, Lai NTY, Suen MMY, Chin VHY, Leung MWY. Long lasting effect on testes following methylene blue injection in laparoscopic lymphatic sparing varicocelectomy. J Pediatr Urol 2022; 19:217.e1-217.e6. [PMID: 36464565 DOI: 10.1016/j.jpurol.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Injection of methylene blue to testis has been shown to have adverse effect in animal studies but it is still being used frequently as lymphatic mapping agent during lymphatic sparing varicocelectomy in adolescent varicoceles. We aim to report postoperative ultrasound changes after subaortic injection of methylene blue in human testes. STUDY DESIGN A retrospective observational study of consecutive patients under 18 years old undergoing laparoscopic varicocelectomy from August 2017 to August 2021 was performed. Demographics such as age, symptoms, pre-operative testicular volume was collected. Primary outcome was change on testicular ultrasound at 3, 6, 12 months after the operation. Secondary outcome was testicular volume difference between affected and unaffected testes, and growth rate of affected testis at 1 year after the operation. RESULTS Fifty-eight patients were included, with median age of 15 years old (IQR 11-18 years). Thirty-one patients had non-lymphatic sparing varicocelectomy (Group A) and 27 patients had lymphatic sparing varicocelectomy (Group B). There was no statistical difference between the mean testicular volume difference between the two groups, but hydrocele rate was significantly higher in Group A (16% vs 0%, p = 0.03). In group B, 6 patients (22.2%, p = 0.005) developed testicular change detectable by ultrasound. No statistical difference could be demonstrated for median testicular size difference (between affected and unaffected testes) at 1 year between group with and without ultrasound change (-23% vs 0%, p = 0.36). Median follow up time was 20.4 months (IQR 5-32 months). DISCUSSION Varicocele treatments improve testicular volume and increase total sperm concentration and lymphatic sparing surgery significantly decreased post-operative hydrocele rates [2]. Different agents have been used to delineate lymphatic vessels and one commonly used agent is methylene blue [10,15-16]. However it has been shown in other animal studies that intraparenchymal injection of methylene blue to rat testis result in degenerative changes [18]. Our study is the first to describe post-operative changes of human testes on imaging after lymphatic sparing varicocelectomy with subdartoic injection of methylene blue. Six patients (22.2%) demonstrated new onset testicular changes on post-operative ultrasound. Although no statistically significant testicular volume reduction was seen in the group with change on imaging, these observations may serve as a surrogate marker for testicular injury or reduced testicular function. It will be desirable for future studies if we can investigate it further with hormonal markers or semen analysis after puberty has been reached. CONCLUSION Lymphatic sparing procedure reduced post-operative hydrocele in adolescent varicocele, however long-lasting effect on testis is evident with subdartoic injection of methylene blue. This agent must be used with caution and long term follow up of these patients are needed.
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Affiliation(s)
- Judy W S Hung
- Department of Surgery, Hong Kong Children's Hospital, Hong Kong.
| | | | - Felix S D Yam
- Department of Surgery, Hong Kong Children's Hospital, Hong Kong
| | - Nancy T Y Lai
- Department of Surgery, Hong Kong Children's Hospital, Hong Kong
| | | | - Vienna H Y Chin
- Department of Surgery, Hong Kong Children's Hospital, Hong Kong
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Ibis MA, Aydos K, Baltaci V, Aktuna S, Yaman O. Can PCNA and LIM15 gene expression levels predict sperm retrieval success in men with non-obstructive azoospermia? Rev Int Androl 2022; 20 Suppl 1:S31-S38. [PMID: 35570072 DOI: 10.1016/j.androl.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/16/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION AND OBJECTIVES It is necessary to be able to predict sperm retrieval before microdissection testicular sperm extraction (mTESE) in azoospermic men. This study established the importance of proliferating cell nuclear antigen (PCNA) and LIM15 gene expression levels in predicting the success of sperm retrieval by mTESE. MATERIALS AND METHODS One hundred and forty-three men who were diagnosed with non-obstructive azoospermia (NOA) were included in the study. Patients' age, total testosterone and follicle stimulating hormone values, testicular volume and testicular histology were recorded by prospectively. PCNA and LIM15 gene expression levels were determined by real-time PCR in the materials from both ejaculate and testicular specimens. RESULTS Testis volume and histology were the most important factors in predicting the sperm retrieval rate (SRR). The PCNA and LIM15 gene expression levels measured in testicular tissues and the LIM15 gene expression levels measured in ejaculate significantly correlated with the SRR in mTESE (p=0.038, p=0.022, and p=0.004, respectively). Although the PCNA gene expression level measured in ejaculate was higher in men with successful sperm retrieval, the difference was not statistically significant (p=0.061). According to the multivariate logistic regression analysis, testicular volume and LIM15 gene expression level in ejaculate were independent predictive parameters for sperm retrieval. CONCLUSION The data showed that LIM15 gene expression level in ejaculate is a useful molecular marker to predict the SRR before mTESE.
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Affiliation(s)
- Muhammed Arif Ibis
- Department of Urology, University of Health Sciences, Kecioren Training and Research Hospital, Ankara, Turkey.
| | - Kaan Aydos
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Volkan Baltaci
- Department of Medical Genetics, Yuksek Ihtisas University School of Medicine, Ankara, Turkey
| | - Suleyman Aktuna
- Department of Medical Genetics, Yuksek Ihtisas University School of Medicine, Ankara, Turkey
| | - Onder Yaman
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
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Liu C, Liu X, Zhang X, Yang B, Huang L, Wang H, Yu H. Referential Values of Testicular Volume Measured by Ultrasonography in Normal Children and Adolescents: Z-Score Establishment. Front Pediatr 2021; 9:648711. [PMID: 33777868 PMCID: PMC7991569 DOI: 10.3389/fped.2021.648711] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 02/08/2021] [Indexed: 12/11/2022] Open
Abstract
Objective: To establish Z-score regression equation derived from age for testicular volume measured by ultrasonography in normal boys aged 0 to 18 years old. Method: The length (L), width (W), and height (H) of 3,328 testicles from 1,664 Chinese boys were measured by ultrasonography. Lambert's formula: L × W × H × 0.71 was used to calculate testicular volume. Z-score regression equation derived from age was established by regression analysis of predicted values of testicular volume and standard deviations. Result: There was no significant difference between left and right testicular volumes. Testicular volume was positively correlated with age, and logarithmic transformation of testicular volume can show a fine curve fit with age. To establish Z-score regression equation derived from age, the predicted values of testicular volume used cubic regression equations, and the standard deviation used square regression equations. The Z-score regression equation derived from age was calculated by the formula: z = [lg (L × W × H × 0.71) - (-0.3524-0.01759 × x+0.009417 × x2-0.0001840 × x3)]/(0.1059+0.01434 × x-0.0005324 × x2). Conclusion: The current study provided a reference value for testicular volume of boys aged 0 to 18 years old. Z-score regression equation derived from age for testicular volume can be established. Z-score will be of great value for the testicular development assessment and disease diagnosis and follow-up.
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Affiliation(s)
- Chen Liu
- Department of Ultrasonography, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiao Liu
- Department of Ultrasonography, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Xiangxiang Zhang
- Department of Ultrasonography, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Boyang Yang
- Department of Ultrasonography, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Lan Huang
- Department of Ultrasonography, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hongying Wang
- Department of Ultrasonography, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hongkui Yu
- Department of Ultrasonography, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Srinivas R, Thomas RJ, Sebastian T, Kurian JJ. Testicular Volume in a Cohort of Prepubertal Indian Children. J Indian Assoc Pediatr Surg 2019; 24:192-196. [PMID: 31258269 PMCID: PMC6568151 DOI: 10.4103/jiaps.jiaps_100_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context: There are orchidometer-based testicular volume nomograms for Indian children; however, accurate and reliable values measured by ultrasound are lacking. Aims: The aim of this study was to (1) measure the testicular volumes of boys from birth to 8 years and generate reference values and (2) to identify factors if any that may influence variation in testicular volumes. Settings and Design: This was a prospective observational study conducted on 320 children in the Department of Pediatric Surgery, Christian Medical College, Vellore, India. Subjects and Methods: A total of 320 boys without any genital abnormalities were studied. The testes were scanned using a linear transducer, and the length, width, and depth of each testis were recorded. Testicular volume was calculated using Lambert's equation – length × width × depth × 0.71. Statistical Analysis Used: Mean testicular volumes and standard deviation for every year of age were calculated. The centile values for testicular volume were computed using R software. Results: Age-specific nomogram of each testis was created separately. Interobserver variability of the measurement was shown to be up to 0.3 ml. No difference was demonstrated in the testicular volumes between the right and left testis. No correlation was found between body weight and body mass index with testicular volume. From the data on differences in size between the two sides, a volume differential index of 27% corresponds to the 95th centile. Conclusions: Reference values have been created for testicular volumes in prepubertal Indian children that could be used to assess the effects of disease and surgical interventions in this age group.
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Affiliation(s)
- Rohith Srinivas
- Department of Paediatric Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Reju Joseph Thomas
- Department of Paediatric Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Tunny Sebastian
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jujju Jacob Kurian
- Department of Paediatric Surgery, Christian Medical College, Vellore, Tamil Nadu, India
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Hung JWS, Yam FSD, Chung KLY, Lau AKW, Leung YCL, Liu CCW, Tang PMY, Chao NSY, Leung MWY, Liu KKW. Comparison of scrotal antegrade sclerotherapy and laparoscopic Palomo surgery in treatment of adolescent varicocele: A 15-year review. J Pediatr Urol 2018; 14:534.e1-534.e5. [PMID: 29941347 DOI: 10.1016/j.jpurol.2018.04.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 04/19/2018] [Indexed: 01/22/2023]
Abstract
INTRODUCTION/OBJECTIVE Varicocele is a common condition seen in adolescence and associated with adult subfertility. Numerous types of intervention have been described with differences in success and complication rates. This study aims to review and compare the surgical outcomes of laparoscopic Palomo surgery and scrotal antegrade sclerotherapy at our center. STUDY DESIGN A retrospective analysis was done of all patients younger than 18 years old with idiopathic varicocele treated operatively between February 2001 and December 2016. Demographics such as age at operation, side, varicocele grade, operative date, and types of operation were collected. Primary outcomes were clinical recurrence, defined as any grading noted on follow-up within 1 year post-op and post-operative hydrocele. Secondary outcomes were operative time, length of stay, and other surgical complications. Mann-Whitney U test, independent t test and chi-square tests were used for analysis. All p-values were two-sided and considered statistically significant at p ≤ 0.05. RESULTS A total of 119 patients fit the criteria, of whom 117 patients were included in data analysis (Table). Sixty-two patients had laparoscopic Palomo surgery (LPS) and 55 had scrotal antegrade sclerotherapy (SAS). Clinical recurrence (grade 2-3) within 1 year was similar between the two groups, with four out of 48 patients in the SAS group and six out of 62 patients in the LPS group (8.4% in SAS vs. 9.7% in LPS, p = 1.00). Of the 11 patients who had recurrence in the SAS group, seven had grade 1 recurrence (14.5%), two (4.2%) had grade 2 recurrence, and two (4.2%) had grade 3 recurrence. For the LPS group, 17 out of 62 patients had clinical recurrence within 1 year, of whom 11 (17.7%) had grade 1 recurrence, one (1.6%) had grade 2, and five (8.1%) had grade 3 recurrence. Post-operative hydrocele was significantly higher in the LPS group; there was none in the SAS group but 11 patients in the LPS group (0% in SAS vs. 17.7%, p = 0.002). Three patients had clinically significant hydrocele requiring Jaboulays' procedure. Complications other than hydrocele were noted in three patients in the SAS group and one patient in the LPS group (5.5% in SAS vs. 1.6% in LPS, p = 0.158). None required operative intervention. No conversion to open procedure was seen in the LPS group and there were no perioperative complications. Mean operative time was 62.9 min in the SAS group and 60.7 min in the LPS group (p = 0.624). Mean length of stay was 17.5 h in the SAS group and 31.7 h in the LPS group (p < 0.001). CONCLUSION Both SAS and LPS are safe procedures for treatment of adolescent varicocele with similar clinical recurrence rate within 1 year. SAS has a significantly lower rate of post-operative hydrocele.
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Affiliation(s)
- Judy W S Hung
- Queen Elizabeth Hospital, Division of Paediatric Surgery, Kowloon, Hong Kong; United Christian Hospital, Division of Paediatric Surgery, Kowloon, Hong Kong.
| | - Felix S D Yam
- Queen Elizabeth Hospital, Division of Paediatric Surgery, Kowloon, Hong Kong; United Christian Hospital, Division of Paediatric Surgery, Kowloon, Hong Kong
| | - Kenneth L Y Chung
- Queen Elizabeth Hospital, Division of Paediatric Surgery, Kowloon, Hong Kong; United Christian Hospital, Division of Paediatric Surgery, Kowloon, Hong Kong
| | - Ambrose K W Lau
- Queen Elizabeth Hospital, Division of Paediatric Surgery, Kowloon, Hong Kong; United Christian Hospital, Division of Paediatric Surgery, Kowloon, Hong Kong
| | - Yvonne C L Leung
- Queen Elizabeth Hospital, Division of Paediatric Surgery, Kowloon, Hong Kong; United Christian Hospital, Division of Paediatric Surgery, Kowloon, Hong Kong
| | - Clarence C W Liu
- Queen Elizabeth Hospital, Division of Paediatric Surgery, Kowloon, Hong Kong; United Christian Hospital, Division of Paediatric Surgery, Kowloon, Hong Kong
| | - Paula M Y Tang
- Queen Elizabeth Hospital, Division of Paediatric Surgery, Kowloon, Hong Kong; United Christian Hospital, Division of Paediatric Surgery, Kowloon, Hong Kong
| | - Nicholas S Y Chao
- Queen Elizabeth Hospital, Division of Paediatric Surgery, Kowloon, Hong Kong; United Christian Hospital, Division of Paediatric Surgery, Kowloon, Hong Kong
| | - Michael W Y Leung
- Queen Elizabeth Hospital, Division of Paediatric Surgery, Kowloon, Hong Kong; United Christian Hospital, Division of Paediatric Surgery, Kowloon, Hong Kong
| | - Kelvin K W Liu
- Queen Elizabeth Hospital, Division of Paediatric Surgery, Kowloon, Hong Kong; United Christian Hospital, Division of Paediatric Surgery, Kowloon, Hong Kong
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Macey MR, Owen RC, Ross SS, Coward RM. Best practice in the diagnosis and treatment of varicocele in children and adolescents. Ther Adv Urol 2018; 10:273-282. [PMID: 30116303 DOI: 10.1177/1756287218783900] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 05/29/2018] [Indexed: 11/17/2022] Open
Abstract
A varicocele is an abnormal dilation of the pampiniform plexus of veins in the scrotum which begins at puberty in approximately 15% of males. Although common in the general population and often asymptomatic, varicoceles are associated with gonadal dysfunction including testicular atrophy, infertility, and hypogonadism in a subset of men diagnosed later in life. Because of the high prevalence and uncertain pathogenesis, definitive management guidelines for varicoceles diagnosed in the pediatric and adolescent population remain poorly defined. The varicocele is the most common etiology of male factor infertility, and treatment in the pediatric and adolescent population may improve semen quality and improve fecundity in adulthood. Evaluation of the pediatric and adolescent varicocele should include history, physical exam, and measurement of testicular volume with orchidometer or ultrasound. Testicular volume differentials and peak retrograde flow on Doppler ultrasonography are important factors in risk stratification of the pediatric varicocele population. Semen analysis and reproductive endocrine assessment should also be considered as part of the workup for adolescent patients. A variety of treatment approaches exist for varicocele, and while the microsurgical subinguinal approach is the gold standard for the adult population, it has yet to be confirmed as superior for the adolescent population. Referral to an andrologist for the adolescent patient with varicocele should be considered in equivocal cases. While active treatment of varicocele in the pediatric and adolescent population is controversial, it is clear that some untreated patients will suffer symptoms later in life, while overtreatment remains a concern for this large, vulnerable population. Therefore, surveillance strategies and improved accuracy in diagnosis of clinically important pediatric varicoceles prompting treatment are needed in the future.
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Affiliation(s)
- Matthew R Macey
- Department of Urology, UNC School of Medicine, Physicians Office Building, 170 Manning Drive, Campus Box #7235, Chapel Hill, NC 27599-7235, USA
| | - Ryan C Owen
- Department of Urology, UNC School of Medicine, Chapel Hill, NC, USA
| | - Sherry S Ross
- Department of Urology, UNC School of Medicine, Chapel Hill, NC, USA
| | - R Matthew Coward
- Department of Urology, UNC School of Medicine, Chapel Hill, NC, USA UNC Fertility LLC, Raleigh, NC, USA
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Valoración del volumen testicular mediante resonancia magnética. Rev Int Androl 2017. [DOI: 10.1016/j.androl.2016.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kurtz MP, Migliozzi M, Rosoklija I, Zurakowski D, Diamond DA. Accuracy of orchidometry in boys with varicocele. J Pediatr Urol 2015; 11:185.e1-5. [PMID: 25910796 DOI: 10.1016/j.jpurol.2015.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 02/20/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Orchidometric evaluation of the testis has been proposed as a cost-effective alternative to measurement of the testis with high-frequency linear ultrasound, which may be costly in terms of hospital resources and patient time. It is known from animal experiments, autopsy series, and small clinical studies that, under ideal conditions, orchidometry may approximate ultrasound measurement. However, little is known of the effectiveness of orchidometry in the clinical setting in a large sample of adolescents with varicocele. OBJECTIVE We sought to analyze the performance characteristics of Rochester orchidometry and its agreement with ultrasound testis volumes in boys with varicocele. STUDY DESIGN Our institutional varicocele database was analyzed from March 2000 to May 2013, including all boys with Rochester orchidometric measurement and ultrasound-based volume measurement performed on the same day. The Lambert formula (L*W*H*0.71) was used to calculate ultrasound volumes. Seven-hundred and twenty measurements were included: 360 of the left testis, and 360 of the right testis. Each subject was included once; in the event of serial measurements the earliest measurement was analyzed. Bland-Altman plots with 95% limits of agreement were used to compare orchidometry and ultrasound measurements. Analysis was performed with JMP, v11 Pro. RESULTS Age at exam ranged from 11.2 to 18.5 years (median 15.8). With respect to varicocele grade, 183 (50.8%) were grade III, 113 (31.4%) were grade II, 42 (11.7%) were grade I, 12 (0.3%) were bilateral, and 10 (0.3%) were ungraded. Mean ultrasound left testis volume was 13.6 cc (SD 6.6) and mean right testis volume was 15.1 cc (SD 6.9). Eleven surgeons performed the orchidometric measurements; one surgeon performed 71% of the exams. Mean overestimation on the right was 2.0 cc (SD 4.2) and on the left was 1.9 cc (SD 4.1); each was highly statistically significant (p < 0.0001, paired t test). Error was correlated with testis size, implying a greater degree of overestimation with increasing volume (p < 0.01, Pearson's correlation 0.09). Amount of volume overestimation and variability was not significantly different for right and left testis. Sensitivity and specificity of Rochester orchidometry to detect a testis volume differential (TVD) of 20% were 33% (95% CI 23-42%) and 96% (95% CI 92-97%), respectively. Testis size, varicocele grade, or examining surgeon had no effect on sensitivity or specificity. DISCUSSION We have shown in a large series of boys with adolescent varicocele that in clinical practice there is a modest degree of overestimation of testis volume on average (1.9-2.0 cc), although there is a large range of volume estimation, such that the 95% confidence interval ranges are quite wide, from approximately 6 cc lower than the true volume to 10 cc greater than the true volume. Furthermore, the low sensitivity (33%) of orchidometry for 20% testis volume differential renders this a suboptimal screening tool for this clinical parameter, which has been shown to be associated with semen analysis outcomes. Knowledge of the performance characteristics of orchidometry is similarly important for research, as factors such as the prevalence of testis volume differential are then dependent on the modality of measurement. Lastly, that this was conducted over a long time course with several surgeons involved suggests that these data reflect real-world application of orchidometry. CONCLUSIONS Appropriate caution should be exercised when relying solely on orchidometric evaluation of the testis. Rochester orchidometry in general appears to overestimate testis size, and there is wide variability in the estimation. In clinical practice, the sensitivity of Rochester orchidometry is modest in detecting a 20% testis volume differential; this difference would be missed in approximately two out of three of boys screened with orchidometry alone.
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Affiliation(s)
- Michael P Kurtz
- Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Matthew Migliozzi
- Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ilina Rosoklija
- Division of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - David Zurakowski
- Department of Anesthesia, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - David A Diamond
- Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Mancini S, Bulotta AL, Molinaro F, Ferrara F, Tommasino G, Messina M. Surgical retroperitoneoscopic and transperitoneoscopic access in varicocelectomy: duplex scan results in pediatric population. J Pediatr Urol 2014; 10:1037-42. [PMID: 24786532 DOI: 10.1016/j.jpurol.2014.02.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 02/21/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This is a retrospective study to compare duplex scan results of laparoscopic Palomo's technique through retroperitoneal and transperitoneal approach for varicocelectomy in children. We statistically analyzed recurrence, testicular volume growth and complications. PATIENTS AND METHODS Surgical intervention was performed utilizing transperitoneoscopic (group A) or retroperitoneoscopic access (group B). Duplex scan control was performed after 12 months (T1), after 2 years (T2) and the last one at 18 years old in most patients. Statistical analysis was performed using the t-test for parametric data. Differences in proportions were evaluated using χ2 or Fisher's exact test. RESULTS We treated 120 children (age range 10-17 years) who presented an asymptomatic IV grade of reflux, Coolsaet 1, associated with a left testicular hypotrophy in 36.6% of the cases (44 patients). No post-operative complications were verified. Duplex scan exam showed an increase of left testicular growth in both groups, with complete hypotrophy disappear in patients in both groups after 24 months. Hydrocele, diagnosed clinically and confirmed with duplex scan, was the most frequent post-operative complication (22/120 cases; 18.3%). CONCLUSIONS This study showed the importance of duplex scan at all steps of this vascular pathology in children, and that there is no significantly difference in results between the two surgical techniques except for hydrocele in transperitoneoscopic access.
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Affiliation(s)
- Stefano Mancini
- Section of Phlebology, Department of General and Specialistic Surgery, University of Siena, 53100 Siena, Italy
| | - Anna Lavinia Bulotta
- Section of Pediatric Surgery, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Policlinico "Le Scotte" Viale Bracci, 53100 Siena, Italy.
| | - Francesco Molinaro
- Section of Pediatric Surgery, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Policlinico "Le Scotte" Viale Bracci, 53100 Siena, Italy
| | - Francesco Ferrara
- Section of Pediatric Surgery, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Policlinico "Le Scotte" Viale Bracci, 53100 Siena, Italy
| | - Giulio Tommasino
- Section of Phlebology, Department of General and Specialistic Surgery, University of Siena, 53100 Siena, Italy
| | - Mario Messina
- Section of Pediatric Surgery, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Policlinico "Le Scotte" Viale Bracci, 53100 Siena, Italy
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Moursy EES, ElDahshoury MZ, Hussein MM, Mourad MZ, Badawy AA. Dilemma of adolescent varicocele: long-term outcome in patients managed surgically and in patients managed expectantly. J Pediatr Urol 2013; 9:1018-22. [PMID: 23523423 DOI: 10.1016/j.jpurol.2013.01.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 01/23/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate outcomes of adolescent varicocele in the case of surgical versus conservative management. METHODS 173 adolescent patients presenting with varicocele were evaluated clinically and sonographically to define varicocele grade and testicular volume. The patients were divided into 2 groups: A (53) with testicular size discrepancy >20% and bilateral varicoceles; B (120) unilaterally affected patients with testicular size discrepancy <20%, who were randomly allocated into 2 equal sub-groups (B1 & B2) of 60 patients. Group A & B1 patients underwent 3× loupe magnified inguinal varicocelectomy while B2 patients were conservatively managed. RESULTS Mean patient age was 14.3 years with mean testicular volume of 11.75 mL and 10.15 mL for right and left testicles, respectively. There were no significant differences between sub-groups B1 & B2 for age, mean testicular volume, size discrepancy and varicocele grade. Mean follow-up of group A & B1 patients was 78 months showing grade I varicocele recurrence (4 cases), catch-up growth in 70% of cases and normal semen analysis in all cases. Mean follow-up of group B2 patients was 79 months showing catch-up growth in 50% of cases and normal semen analysis in all but 1 case. Four cases were shifted to surgical treatment due to reduction of testicular size (2 cases), varicocele upgrade (1 case) and oligoasthenospermia (1 case). At the last follow-up, the mean testicular volume for groups A, B1 & B2 was 16.2, 16.45 & 16.3 mL for right testes and 14.7, 15.6 & 15.2 mL for left testes, respectively. There was significantly better catch-up growth in sub-group B1 compared to B2 but the testicular volume was not statistically different. CONCLUSIONS Although adolescent varicocelectomy was associated with a higher percentage of patients showing testicular catch-up growth, the mean testicular volume was not significantly different. Further studies are needed to report on paternity among those patients.
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Morphological and surgical overview of adolescent testis affected by varicocele. ScientificWorldJournal 2013; 2013:469413. [PMID: 24348160 PMCID: PMC3856136 DOI: 10.1155/2013/469413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 10/08/2013] [Indexed: 12/04/2022] Open
Abstract
Varicocele is a common pathology of the testis frequently associated with infertility. For its management, a fine morphological study of the testis, both macroscopically and microscopically, and an accurate choice of surgical procedure are mandatory. The present review focuses its attention on the anatomic substrates of adolescent varicocele and its pathophysiologic modifications. The comprehensive assessment of all the reported alterations should be considered by the clinician before deciding the type of treatment and the timing.
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Active surveillance of the adolescent with varicocele: predicting semen outcomes from ultrasound. J Urol 2013; 191:1401-6. [PMID: 24231835 DOI: 10.1016/j.juro.2013.11.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2013] [Indexed: 11/22/2022]
Abstract
PURPOSE We hypothesized that active surveillance of the adolescent varicocele is not associated with a high prevalence of suboptimal semen analysis and that patients with abnormal semen analysis have smaller testicular volumes and larger volume differentials. MATERIALS AND METHODS We conducted an institutional review board approved retrospective cohort study of adolescents with a clinically detected varicocele. Patients were initially observed by serial scrotal ultrasound evaluating testicular size and differential. Semen analysis was routinely collected in Tanner V cases, around age 18 years. Prevalence of normal semen analysis parameters was calculated, and logistic regression was used to model the ability of age at presentation and testicular volume parameters to predict a normal semen analysis. RESULTS A cohort of 73 patients underwent surveillance with a mean ± SD age at presentation of 15.5 ± 2.3 years. Median followup was 2.7 years, during which time subjects underwent a median of 3 scrotal ultrasounds. A low total motile count was found in 48 patients (66%). Neither age at presentation nor testicular volume differential could predict normal semen volume, density, sperm motility or total motile count. Total testicular volume from the final ultrasound predicted total motile count (p = 0.008). However, the collective observations of volume during the entire period of surveillance could not predict total motile count (p = 0.847). CONCLUSIONS There is a high prevalence of suboptimal semen analysis in adolescents with a varicocele who are followed with active surveillance. Total testicular volume can predict total motile count at the end of adolescence but not throughout.
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Mbaeri T, Orakwe J, Nwofor A, Oranusi C, Mbonu O. Ultrasound measurements of testicular volume: Comparing the three common formulas with the true testicular volume determined by water displacement. AFRICAN JOURNAL OF UROLOGY 2013. [DOI: 10.1016/j.afju.2012.11.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Bryniarski P, Kaletka Z, Huk J, Fryczkowski M, Prokopowicz G, Zyczkowski M, Muskała B, Taborowski P, Paradysz A. Testicular volume and fertility potential in men operated due to varicocele and testicular hypotrophy in adolescence. Cent European J Urol 2013; 66:56-9. [PMID: 24578992 PMCID: PMC3921857 DOI: 10.5173/ceju.2013.01.art18] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 11/29/2012] [Accepted: 12/16/2012] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Failure to perform surgical repair of varicocele before puberty is among the common causes of male infertility. The purpose of this study was to evaluate the testicular volume and fertility potential in men after laparoscopic varicocelectomy conducted in adolescence due to varicocele and concomitant testicular hypotrophy. MATERIAL AND METHODS From 1996 through 2011, eighty-two adolescents were operated on for unilateral primary varicocele with testicular hypotrophy. Sixty-eight patients were subject to the current analysis. The age of the patients was 13 to 17 years (mean 15.3 years). Clinical diagnosis was established on the basis of andrologic examination and ultrasonography with an assessment of testicular size and varicocele severity. Laparoscopic surgical repair was performed by a transperitoneal approach with division of testicular vein only. RESULTS An increase in left testicular volume when compared with the contralateral testis was found in 25 (78.1%) young men with clinical grade 2 varicocele (p = 0.02) and in 32 (88.8%) subjects with grade 3 abnormality (p = 0.04). An increase in left testicular volume was found in 46 (85.1%) of 54 patients with unilateral varicocele and in 12 (85.7%) of 14 subjects operated on for bilateral disease. A left testicular volume increase was comparable independent of the use of uni- or bilateral repair. Fifty-eight (85.2%) of our 68 patients had normozoospermia. CONCLUSIONS Laparoscopic varicocele repair resulted in a significant increase of hypotrophic testicular volume in 83.8% of our subjects.
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Affiliation(s)
- Piotr Bryniarski
- Department of Urology, Silesian Medical University, Zabrze, Poland
| | - Zbigniew Kaletka
- Department of Urology, Silesian Medical University, Zabrze, Poland
| | - Jacek Huk
- Department of Urology, Silesian Medical University, Zabrze, Poland
| | | | | | | | - Bartosz Muskała
- Department of Urology, Silesian Medical University, Zabrze, Poland
| | - Piotr Taborowski
- Department of Urology, Silesian Medical University, Zabrze, Poland
| | - Andrzej Paradysz
- Department of Urology, Silesian Medical University, Zabrze, Poland
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Individual variation related to testicular biometry and semen characteristics in collared peccaries (Tayassu Tajacu Linnaeus, 1758). Anim Reprod Sci 2012; 134:191-6. [DOI: 10.1016/j.anireprosci.2012.08.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 07/16/2012] [Accepted: 08/18/2012] [Indexed: 11/17/2022]
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Abstract
During adolescence, the risk of developing a varicocele increases. Prevalence is less than 1% in boys aged younger than 10 years, but approaches that of the general adult population (about 15%) during puberty. For adolescent males with varicoceles, surgical risk factors have not yet been clearly delineated and clinical severity correlates poorly with prognosis. Fortunately, the widespread use of Doppler ultrasonography is transforming the diagnostic work-up for this demographic. A continuous reflux detected by color Doppler ultrasound (CDUS) is thought to have a negative prognostic value and evidence suggests that a peak retrograde flow above 38 cm per second is a powerful predictor of lack of spontaneous improvement in adolescent patients with ≥ 20% asymmetry between testes. CDUS also enables the detection of varicocele resulting from reflux in the deferential vein adjunctive to a refluxing internal spermatic vein; a causality that accounts for approximately 15% of cases. In addition to a diagnostic role, hemodynamic parameters can be used to predict the risk of persistence or worsening asymmetry. Although further studies are necessary to validate single parameters, it seems that the more severe the reflux, the greater the likelihood that the patient will develop testicular asymmetry.
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Testicular volume discrepancy is associated with decreased semen quality in infertile Japanese males with varicoceles. Reprod Med Biol 2012; 11:117-121. [PMID: 29662361 DOI: 10.1007/s12522-011-0118-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 12/28/2011] [Indexed: 10/14/2022] Open
Abstract
Purpose We retrospectively reviewed infertile Japanese males for testicular volume discrepancies (D) and semen parameters to evaluate whether left grade II-III varicoceles (V) cause testicular damage. Methods Seventy-seven patients who had idiopathic male infertility and 88 who had V without other causes of infertility were examined. We excluded cases of azoospermia. Testicular volume was measured using a punched-out orchidometer. D was defined as a size difference of at least 3 ml. The frequency of D was compared between the patients with and without V. The semen parameters were reviewed in association with D and V. Results The mean left and right testicular volumes were 19.4 and 20.1 ml, respectively (p < 0.001). D with a smaller left testis was more common in V+ cases than in V- cases (26.1 vs. 13.0%, p = 0.0351). The sperm count and motility were also significantly lower (p = 0.0213 and p = 0.0217, respectively) in the D+ patients with a smaller left testicular volume. Conclusions In the patients with V, D was more common than in those without V. The semen parameters were worse if D was present in the patients with V. These results indicated that V could induce testicular atrophy and negatively affect semen quality. Therefore, the ipsilateral reduced testicular volume is considered to be a sign of persisting testicular damage by V.
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Spinelli C, Di Giacomo M, Lo Piccolo R, Martin A, Messineo A. The role of testicular volume in adolescents with varicocele: the better way and time of surgical treatment. J Urol 2010; 184:1722-6. [PMID: 20728113 DOI: 10.1016/j.juro.2010.06.057] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE We report varicocele prevalence in adolescents. Surgical treatment has been proposed in adolescents with relevant testicular disproportion to avoid fertility problems in adulthood. We prospectively analyzed the testicular volume variation in adolescents with varicocele and hypoplastic testis. MATERIALS AND METHODS In a 2-year period we selected 54 consecutive pediatric patients with a median age of 14.5 years (range 13 to 16) who had left varicocele using certain criteria, including testicular volume discrepancy greater than 20%, no previous inguinal-testicular surgery and no symptoms. Adolescents were divided into 2 groups, including 27 who underwent surgical correction with lymphatic sparing microsurgical varicocelectomy (intervention) and 27 who were only observed (control). After surgery or at first observation patients were evaluated clinically and by ultrasound at 3, 6 and 12 months. Testicular volume was estimated by the prolate ellipsoid formula. RESULTS We noted significant improvement in testicular volume with less than 20% disparity between the 2 gonads in 23 patients (85.2%) in the intervention group and in 8 controls (29.6%). Two recurrences (7.4%) were reported in the intervention group, each in an adolescent with increased testicular volume. CONCLUSIONS Our study confirms significantly increased testicular volume in many surgically treated boys and shows that physiological catch-up growth occurs in adolescents with varicocele without treatment. Considering critically results in each group, in select cases clinical and ultrasound followup is indicated before intervention due to a possible spontaneous decrease in testicular asymmetry. Further histopathological studies are needed to identify the relationship between testicular hypoplasia, irreversible damage and future fertility problems to determine which adolescents should be treated.
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Abstract
A varicocele is a dilatation of the testicular vein and the pampiniform venous plexus within the spermatic cord. Although rare in pediatric populations, the prevalence of varicoceles markedly increases with pubertal development. Varicoceles are progressive lesions that may hinder testicular growth and function over time and are the most common and correctable cause of male infertility. Approximately 40% of men with primary infertility have a varicocele, and more than half of them experience improvements in semen parameters after varicocelectomy. The decision to treat adolescents with varicocele is a controversial one. The task for pediatricians and urologists is to identify those adolescents who are at greatest risk for infertility in adulthood, in an effort to offer early surgical intervention to those most likely to benefit.
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Affiliation(s)
- Samuel P Robinson
- Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, VA 23298-0118, USA
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Prevalence of Testicular Size Discrepancy in Infertile Men With and Without Varicoceles. Urology 2010; 75:566-8. [DOI: 10.1016/j.urology.2009.08.084] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Revised: 08/05/2009] [Accepted: 08/18/2009] [Indexed: 11/18/2022]
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Poon SA, Gjertson CK, Mercado MA, Raimondi PM, Kozakowski KA, Glassberg KI. Testicular asymmetry and adolescent varicoceles managed expectantly. J Urol 2010; 183:731-4. [PMID: 20022048 DOI: 10.1016/j.juro.2009.10.028] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Indexed: 11/17/2022]
Abstract
PURPOSE Adolescent varicocele is often associated with testicular asymmetry. Depending on the degree of asymmetry, some physicians will recommend surgery. However, given the possibility that asynchronous growth may be transient, others advocate for a period of observation. We reviewed our outcomes in such patients who were initially treated expectantly. MATERIALS AND METHODS We retrospectively reviewed our pediatric varicocele database. We analyzed the outcomes of patients presenting for evaluation of varicocele who were followed with serial testicular volume measurements using scrotal ultrasound or ring orchidometry and who had at least a 6-month interval between measurements. Fisher's exact test was used to compare groups based on initial and final testicular asymmetry. RESULTS We identified 181 patients (median age 13.8 years) who were followed expectantly. Serial volume measurements had been obtained at a median interval of 12 months (interquartile range 8 to 21) between first and most recent visits. Mean percent asymmetry for the group did not change with time. Among patients who initially had less than 20% asymmetry 35% had 20% or greater asymmetry on followup, and among those with 20% or greater asymmetry initially 53% remained in that range (p = 0.007). CONCLUSIONS Asymmetry can be a transient phenomenon. Patients with initial asymmetry can end up with significant asymmetry, and many with significant asymmetry can have catch-up growth. However, when patients have a peak retrograde flow of 38 cm per second or greater on duplex Doppler ultrasound in association with 20% or greater asymmetry spontaneous catch-up growth is unlikely to occur.
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Affiliation(s)
- Stephen A Poon
- Department of Urology, Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA
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Queiroz JPAF, Barros FFPC, Lima GL, Castelo TS, Freitas CIA, Silva AR. Assessment of Orchidometry and Scrotal Circumference in Coatis (Nasua nasua). Reprod Domest Anim 2010; 45:e382-6. [DOI: 10.1111/j.1439-0531.2010.01582.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kabay S, Yucel M, Ozden H, Yaylak F, Ozbek O, Gumusalan Y. Magnetic Resonance Imaging Is a Complementary Method to Stereological Measurement of Testicular Volume. Urology 2009; 73:1131-5. [DOI: 10.1016/j.urology.2008.02.058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2007] [Revised: 02/26/2008] [Accepted: 02/29/2008] [Indexed: 11/24/2022]
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Hsieh ML, Huang ST, Huang HC, Chen Y, Hsu YC. The reliability of ultrasonographic measurements for testicular volume assessment: comparison of three common formulas with true testicular volume. Asian J Androl 2009; 11:261-5. [PMID: 19151736 DOI: 10.1038/aja.2008.48] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The aim of this study was to determine the correlation of ultrasonographic estimates of testicular volume with true testicular volume and to compare the accuracy and precision of the three most commonly utilized formulas. A total of 15 patients underwent high-resolution ultrasonography (US) analysis for testicular volume before orchiectomy. Testicular volume was calculated using three common formulas: (1) length (L) x width (W) x height (H) x 0.52; (2) the empirical formula of Lambert: L x W x H x 0.71; and (3) L x W2 x 0.52. The actual volume of each removed testis was estimated directly by a water displacement method. Thus, four volume measurements were obtained for each of the 30 testes. The obtained data were analyzed by paired t-test and linear regression analysis. All three US formula measurements significantly underestimated the true testicular volume. The largest mean biases were observed with US formula 1, which underestimated the true volume by 3.3 mL (31%). US formula 2 had a smaller mean difference from the true volume, with an underestimation of only 0.6 mL (6%). Regression analysis showed that formulas 1 and 2 had better R2 values than formula 3. However, all three US formulas displayed a strong linear relationship with the true volume (R2= 0.872-0.977; P < 0.001). Among the commonly used US formulas, the empirical formula of Lambert (L x W x H x 0.71) provided better accuracy than the other two formulas evaluated, and better precision than formula 3. Therefore, the formula of Lambert is the optimal choice in clinical practice.
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Affiliation(s)
- Ming-Li Hsieh
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, No. 5, Fu-Shing Street, Kweishan, Taoyuan 333, Taiwan, China.
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Gouletsou PG, Galatos AD, Leontides LS. Comparison between ultrasonographic and caliper measurements of testicular volume in the dog. Anim Reprod Sci 2008; 108:1-12. [PMID: 17723281 DOI: 10.1016/j.anireprosci.2007.06.020] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Revised: 06/12/2007] [Accepted: 06/19/2007] [Indexed: 11/15/2022]
Abstract
The aim of this study was to compare the accuracy of two methods used to clinically estimate testicular volume in the dog. Caliper and ultrasonographic measurements of testicular dimensions (length, width and height) of both testes were performed on 21 adult Beagles. Either measurement was taken in vivo over the scrotal skin and again in vitro after castration, excluding or including, when possible, the epididymis. In a sub-sample of 14 testes of 7 randomly selected dogs, the testicular volume was calculated by the formula of an ellipsoid: length (l)xwidth (w)xheight (h)x0.5236, and the empiric formula of Lambert: (l)x(w)x(h)x0.71. The calculated volumes were then compared to the actual ones, which were estimated by water displacement. For each measurement method, the formula that estimated more accurately the true testicular volume was, subsequently, applied to the calculation of the testicular volume of the remaining testes. The formula of ellipsoid estimated testicular volume more accurately when in vivo and in vitro caliper measurements and in vitro ultrasound measurements were performed. The formula of Lambert estimated testicular volume more accurately when in vivo ultrasound measurements were performed. The volumes calculated from the measurements of calipers over the scrotal skin overestimated true volumes, on average, by 69+/-27% (concordance correlation coefficient r(ccc)=0.49). By contrast, those calculated from the ultrasonography measurements were more accurate, overestimating the true volumes by 17+/-24% (rccc=0.81). Therefore, ultrasonography when the formula of Lambert is used is more accurate than caliper methods for the estimation of testicular volume in clinical practice and should be the method of choice.
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Affiliation(s)
- Pagona G Gouletsou
- Clinic of Obstetrics and Reproduction, Faculty of Veterinary Medicine, University of Thessaly, Trikalon 224, GR-43100 Karditsa, Greece
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Kolon TF, Clement MR, Cartwright L, Bellah R, Carr MC, Canning DA, Snyder HM. Transient asynchronous testicular growth in adolescent males with a varicocele. J Urol 2008; 180:1111-4; discussion 1114-5. [PMID: 18639288 DOI: 10.1016/j.juro.2008.05.061] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE We assessed the testicular growth of adolescent males followed nonsurgically for the presence of left varicocele. MATERIALS AND METHODS We retrospectively reviewed the charts of adolescent males with a diagnosis of unilateral left varicocele and ultrasound testis volume measurements seen during a 10-year period. A total of 161 boys underwent at least 2 testicular ultrasounds as part of the evaluation for left varicocele. Patients were excluded from study for a history of inguinal/scrotal pathology or endocrinopathy that could affect testicular size. Sonographic testicular volume was calculated using the Lambert volume (length x width x height x 0.71). The resulting volumes were compared to previously published criteria for surgical repair (15%, 20% and 2 cc size differentials). RESULTS Of the 71 boys with 3 followup ultrasounds 38 (54%) initially had a 15% or greater volume differential. After nonsurgical followup with ultrasounds for 2 years 60 boys (85%) had testicular volume differentials in the normal range (less than 15%). Of the patients 71% were spared potential surgery by size criteria and 50% were spared surgery by the same 15% volume differential criteria. CONCLUSIONS Adolescent males with unilateral left varicocele often demonstrate asynchronous testicular growth that usually equalizes in time. Therefore, sonographic testicular size measurement at a single point during adolescence is insufficient to determine the need for varicocelectomy. When contemplating varicocelectomy we recommend at least 2, and preferably 3, testicular volume measurements 1 year apart to establish accurately decreased left testicular volume compared to a normal right testis.
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Affiliation(s)
- Thomas F Kolon
- Division of Urology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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Zampieri N, Zuin V, Corroppolo M, Ottolenghi A, Camoglio FS. Relationship between varicocele grade, vein reflux and testicular growth arrest. Pediatr Surg Int 2008; 24:727-30. [PMID: 18421464 DOI: 10.1007/s00383-008-2143-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2008] [Indexed: 12/18/2022]
Abstract
The development of testicular hypotrophy (or testicular growth arrest) in pediatric patients with varicocele is the first indication for surgery. The aim of this study is to identify the correlation between grade of varicocele, grade of vein reflux and testicular growth arrest. Between 2000 and 2001, we recruited 226 patients affected by varicocele without testicular hypotrophy and with grades 2-3 spermatic vein reflux observed during Doppler velocimetry. Medical examinations carried out every 6 months allowed the assessment of varicocele grade, testicular volume, and grade of vein reflux. Other parameters considered in the study were: mean time of grade deterioration, mean time to onset of testicular growth arrest and the relationship between varicocele grade and testicular growth arrest. Deterioration of the condition was experienced in 92 patients (40%) in which 60 patients showed higher varicocele grades without testicular growth arrest, while 32 patients developed testicular growth arrest. There was a statistically significant relationship between testicular growth arrest and varicocele grades (grade 2 and 3) and between grade of reflux and testicular growth arrest. Although it is not possible to determine which patients will develop testicular growth arrest, the assessment of vein reflux allows the identification of those subjects who may potentially develop such a condition.
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Affiliation(s)
- Nicola Zampieri
- Department of Surgical Sciences, Pediatric Surgical Unit, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro n. 1-Verona, 37134, Verona, Italy.
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Sakamoto H, Ogawa Y, Yoshida H. Relationship Between Testicular Volume and Varicocele in Patients With Infertility. Urology 2008; 71:104-9. [DOI: 10.1016/j.urology.2007.08.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2007] [Revised: 06/27/2007] [Accepted: 08/10/2007] [Indexed: 10/22/2022]
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Zampieri N, Corroppolo M, Zuin V, Cervellione RM, Ottolenghi A, Camoglio FS. Longitudinal Study of Semen Quality in Adolescents with Varicocele: To Treat or Not? Urology 2007; 70:989-93. [DOI: 10.1016/j.urology.2007.07.061] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Revised: 06/21/2007] [Accepted: 07/18/2007] [Indexed: 10/22/2022]
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Eijsbouts SW, de Muinck Keizer-Schrama SMPF, Hazebroek FWJ. Further Evidence for Spontaneous Descent of Acquired Undescended Testes. J Urol 2007; 178:1726-9. [PMID: 17707013 DOI: 10.1016/j.juro.2007.03.184] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Indexed: 10/22/2022]
Abstract
PURPOSE It is still controversial whether acquired undescended testis can best be managed by orchiopexy or by the wait and see method. We prospectively evaluated spontaneous descent of acquired undescended testes and possible predictive factors in prepubertal boys. MATERIALS AND METHODS From 1982 to 2004 spontaneous descent was awaited until at least Tanner stage P2G2 in 109 boys with a total of 83 unilateral and 52 bilateral acquired undescended testes. Annually we established testis position and size. After Tanner stage P2G2 orchiopexy was done for all testes in an unstable scrotal position. RESULTS Two boys (3 acquired undescended testes) were excluded from analysis. Of 132 acquired undescended testes 75 descended spontaneously (57%, 95% CI 48-65), including 40 of 75 (57%) in early puberty or before puberty and 32 of 75 (43%) in mid puberty. Orchiopexy was performed in 57 of 132 acquired undescended testes (43%). Acquired undescended testes showed an increasing chance of descending spontaneously with increasing age (p trend = 0.002). In 63 of 82 unilateral undescended testes we were able to compare testis volume at the onset of puberty with that of the healthy contralateral side. Of 17 testes that needed orchiopexy 12 (71%) had a volume that was more than 1 ml smaller than the healthy testis. This was noted in only 18 of 46 spontaneously descended acquired undescended testes (39%, p = 0.053). Other factors, such as the most caudal testicular position at referral or the frequency of confirmed descended testicular position before referral, were not predictive of spontaneous descent. CONCLUSIONS A conservative wait and see approach to acquired undescended testis until puberty could prevent more than half of the boys from undergoing orchiopexy and it does not seem detrimental in terms of testicular volume.
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Affiliation(s)
- S W Eijsbouts
- Department of Pediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.
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Donkol RH, Salem T. Paternity after varicocelectomy: preoperative sonographic parameters of success. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:593-9. [PMID: 17460001 DOI: 10.7863/jum.2007.26.5.593] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE This study was done to assess the sonographic findings that could predict the outcome of varicocele repair in the treatment of male infertility/subfertility related to varicocele. METHODS This was a retrospective study and follow-up of 107 selected patients with male factor infertility related to the presence of varicocele. The patients were classified into 2 groups according to their estimated testicular size by sonography. Group 1 included 80 patients with normal-sized testes (>15 cm(3)), and group 2 included 27 patients with small testes (10-15 cm(3)). The mean age +/- SD was 34 +/- 11 years. The mean duration of infertility was 3.4 +/- 1.4 years. They had oligospermia, asthenospermia, or oligoasthenospermia. The patients underwent low ligation varicocelectomy and were followed for 18 to 45 months after surgery for occurrence of paternity. Their scrotal sonographic findings were reviewed and correlated with the postoperative paternity rate. RESULTS Postoperative paternity was achieved in 24 patients (30%) of group 1 with normal-sized testes and in 3 patients (11%) of group 2 with small testes. In patients of group 1, the positive paternity rate was higher (36.6%) in patients with clinically detected varicocele, compared with only 16% of patients with subclinical varicocele. In addition, postoperative paternity was significantly higher in patients with bilateral varicocele (54.5%; P = .0099), patients with shunt-type varicocele (75%; P = .0117), and patients with a permanent grade of venous reflux (70%; P = .0148). No significant differences were noted between positive paternity rates in patients with mildly or markedly dilated veins. CONCLUSIONS The best preoperative sonographic parameters of success of varicocele repair are the presence of normal-sized testes, clinically palpable veins, bilateral varicocele, shunt-type varicocele, and a permanent grade of venous reflux. It does not matter how much the veins are dilated.
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Affiliation(s)
- Ragab H Donkol
- Department of Radiology, Cairo University, Cairo, Egypt.
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Affiliation(s)
- Kenneth I Glassberg
- Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, 3959 Broadway, CHN 11-1118N, New York, NY 10032, USA.
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Sakamoto H, Saito K, Oohta M, Inoue K, Ogawa Y, Yoshida H. Testicular volume measurement: comparison of ultrasonography, orchidometry, and water displacement. Urology 2007; 69:152-7. [PMID: 17270639 DOI: 10.1016/j.urology.2006.09.012] [Citation(s) in RCA: 148] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2006] [Revised: 06/22/2006] [Accepted: 09/07/2006] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To determine the accuracy of orchidometry and ultrasonography for measuring the testicular volume by comparing the resultant measurements with the actual testicular volume in humans. METHODS The testicular volume of 40 testes from 20 patients with prostate cancer (mean age +/- SD 74.5 +/- 7.5 years) was measured using the Prader orchidometer and ultrasonography before therapeutic bilateral orchiectomy. The ultrasound measurements of testicular volume were calculated using three formulas: length (L) x width (W) x height (H) x 0.52, L x W2 x 0.52, and L x W x H x 0.71. The actual testicular volumes were determined by water displacement of the surgical specimen. RESULTS The mean actual testicular volume of the 40 testes was 9.3 cm3 (range 2.5 to 23.0). A strong correlation was found between the testicular volume calculated by the three ultrasound formulas and the actual volume (r = 0.910 to 0.965, P <0.0001) and was stronger than the correlation with the Prader orchidometer (r = 0.818, P <0.0001). The smallest mean difference from the actual testicular volume was observed with the formula L x W x H x 0.71, which overestimated the actual volume by 0.80 cm3 (7.42%). The measurements using the Prader orchidometer correlated with the actual testicular volume and with the testicular volume calculated using the three ultrasound formulas (r = 0.801 to 0.816, P <0.0001). However, the orchidometer measurements had the largest mean difference from the actual testicular volume (6.68 cm3, 81.7%). CONCLUSIONS The results of this study have shown that measuring the testicular volume by ultrasonography is more accurate than by the Prader orchidometer, and the formula L x W x H x 0.71 was the most accurate for calculating the testicular volume.
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Affiliation(s)
- Hideo Sakamoto
- Department of Urology, Showa University School of Medicine, Tokyo, Japan.
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Sakamoto H, Saito K, Ogawa Y, Yoshida H. Testicular Volume Measurements Using Prader Orchidometer Versus Ultrasonography in Patients with Infertility. Urology 2007; 69:158-62. [PMID: 17270640 DOI: 10.1016/j.urology.2006.09.013] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2006] [Revised: 06/15/2006] [Accepted: 09/07/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To compare the accuracy of testicular volume measurements with the Prader orchidometer versus ultrasonography. METHODS The volume of 938 testes in 469 men with infertility (mean age 35.8 years) was measured using a Prader orchidometer and by ultrasonography. The ultrasound testicular volumes were calculated using the formula length x width x height x 0.71. To compare any differences between the methods according to testicular size, the patients were divided into six groups according to the ultrasound-determined volume: less than 5, 5 to 10, 10 to 15, 15 to 20, 20 to 25, and 25 cm3 or more. RESULTS The mean volume by orchidometry and ultrasonography was 18.7 and 13.7 cm3 for the right testis and 18.0 and 12.5 cm3 for the left, respectively, and was significantly overestimated by orchidometry (P <0.0001; by 5.1 cm3 on the right and 5.5 cm3 on the left). The largest differences between methods were observed for volumes of 10 to 15 cm3 on the right and 5 to 10 cm3 on the left. The difference between the methods decreased as the ultrasound-determined volume increased (r = 0.636 on the right; r = 0.598 on the left testis). Nonetheless, the Prader orchidometric measurements showed a strong correlation with the ultrasound measurements (r = 0.707 on the right; r = 0.746 on the left). CONCLUSIONS The testicular volume estimated by Prader orchidometry correlated closely with the measurements by ultrasonography. However, the orchidometer overestimated the testicular volume, especially in small testes.
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Affiliation(s)
- Hideo Sakamoto
- Department of Urology, Showa University School of Medicine, Tokyo, Japan.
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Karaman MI, Kaya C, Caskurlu T, Guney S, Ergenekon E. Measurement of pediatric testicular volume with Prader orchidometer: comparison of different hands. Pediatr Surg Int 2005; 21:517-20. [PMID: 16010550 DOI: 10.1007/s00383-005-1470-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2005] [Indexed: 11/24/2022]
Abstract
Measurement of testicular volume is a more readily available method of estimating spermatogenesis in adolescence. Traditionally, testicular volumes have been measured with different type of orchidometers or calipers. The most widely used orchidometer is the Prader orchidometer introduced in 1966. This type of orchidometer, a graded series of ellipsoid beads on a string, is used for testicular volume measurement, which is a useful index of puberty in male in order to evaluate male growth and development. Although it is more practical and inexpensive compared with ultrasonography, this instrument has been questioned in regard to its objectiveness in different hands. We designed a prospective clinical study to investigate the correlation between testicular size measurements of three different clinical investigators by using Prader orchidometer. A total of 100 testes in 50 boys with a mean age of 6.4 years (range 1-15 years) who presented to Urology and Pediatrics outpatient clinics of our hospital without urogenital complaints were enrolled to this study. The volumes of each testis were measured independently using Prader orchidometer by three different clinical investigators (A, B and C). Each investigator repeated testicular volume measurements blinded to measurements obtained by others. The measured volumes were recorded separately. Statistical analysis of the results was performed using Pearson's correlation (r) to determine the correlation of orchidometer measurements between the examiners. All statistical analyses and power calculations were performed using computer software. Mean testicular volumes measured by three examiners A, B and C were 4.01+/-3.79 ml (SD) (2-18 ml), 3.66+/-3.46 ml (SD) (1-18 ml) and 3.86+/-3.54 ml (SD) (1-18 ml), respectively. The statistical correlation between the measurements of investigator A and B, A and C, and B and C showed a high correlation {r = 0.954 (P < 0.01), r = 0.964 (P < 0.01), and r = 0.979 (P < 0.01)}, respectively. In the present study, it was shown that testicular size measurement by using Prader orchidometer gives good correlation in different examiners' hands and it is an objective and reliable method in pediatric urological practice.
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Affiliation(s)
- M Ihsan Karaman
- Department of Urology, Haydarpasa Numune Training and Research Hospital, Bulgurlu mah, Esatpasa cad, Eksioglu Uygarkent sit, A4 blk D:17, Istanbul, Turkey
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Abstract
OBJECTIVE Varicocelectomy has long been a therapeutic modality used in the treatment of male infertility. In the past decade, adolescent varicocelectomy has become a frequent procedure to preserve testicular growth and to help prevent future infertility. Because our clinical population includes a large portion of orthodox Jews who traditionally marry early and are forbidden to use birth control by religious law, we thought that by studying our patients, we might be able to accelerate our follow-up regarding paternity. In addition, we wanted to learn whether adolescent varicocelectomy might have any negative impact. METHODS Questionnaires inquiring as to the marital and paternity status, postoperative course, and complications were sent to 50 patients who had undergone a unilateral or bilateral varicocele repair during adolescence and who were at least 21 years old at the time of this review. In addition, a careful chart review was performed to examine the perioperative and postoperative parameters of each respondent. RESULTS Of the 43 responses (86% response rate), 18 of 18 patients who had attempted to father a child were successful. The remaining 25 were not married or had never attempted to father a child. In the paternity group, 10 of the fathers had undergone an Ivanissevich repair; the remaining 8 had a Palomo repair. Sixteen of the 18 had unilateral varicocelectomies, and 2 underwent bilateral repairs. Of those with a unilateral varicocele, the indication for surgery in 10 was a grade 2 to 3 varicocele associated with a >20% volume difference when compared with the right testicle. Three had 10% to 20% volume loss, whereas the remaining three had unusually large grade 3 varicoceles without concurrent volume difference. CONCLUSIONS Varicocelectomy in the adolescent population has been proposed as a therapeutic intervention to preserve both fertility and testicular growth. Although not showing a cause-and-effect relationship, it is our contention that varicocelectomy in adolescence at worst does no harm and at best preserves fertility.
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Affiliation(s)
- Elan W Salzhauer
- Department of Urology, State University of New York, Downstate Medical Center, Brooklyn, New York, USA
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Abstract
Whether to treat adolescents with varicocele is controversial because over 80% of adult varicoceles are not associated with infertility. Most physicians agree that treating all adolescents with varicocele and subjecting boys to unnecessary surgery is inappropriate,costly, and not without ethical considerations. Waiting until patients present as adults with potentially irreversible infertility, however, is equally unacceptable. Pediatricians and urologists must determine which adolescents are at greatest risk for future fertility problems and warrant early intervention. This article reviews the current literature surrounding adolescent varicocele and offers recommendations for identifying individuals who would most benefit from treatment.
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Affiliation(s)
- Gary W Bong
- Division of Urology, Virginia Commonwealth University - Medical College of Virginia, 1200 East Broad Street, P.O. Box 980118, Richmond, VA 23298, USA
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Adelman WP, Joffe A. Controversies in male adolescent health: varicocele, circumcision, and testicular self-examination. Curr Opin Pediatr 2004; 16:363-7. [PMID: 15273494 DOI: 10.1097/01.mop.0000131451.41322.43] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The authors review three common clinical controversies encountered by primary care providers of adolescent males: management of varicoceles, the role of circumcision in the acquisition and transmission of sexually transmitted infections, and the value of teaching testicular self-examination. RECENT FINDINGS Recent findings in adolescent varicoceles have advanced knowledge regarding the cause of varicoceles, the mechanism by which they may lead to infertility, new screening methods, and optimal surgical management. Accumulating evidence shows circumcision to be protective against acquisition and transmission of sexually transmitted infections, and preliminary work also indicates the potential for protection against the spread of AIDS in Africa. Testicular self-examination remains an unproven screening modality that is suboptimally performed by at-risk patients. SUMMARY This review updates the provider on these topics and clarifies issues involved in these controversies
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Affiliation(s)
- William P Adelman
- Department of Adolescent Medicine, National Naval Medical Center, Bethesda, Maryland 20889, USA.
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Tarhan S, Gümüs B, Gündüz I, Ayyildiz V, Göktan C. Effect of varicocele on testicular artery blood flow in men--color Doppler investigation. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 2003; 37:38-42. [PMID: 12745742 DOI: 10.1080/00365590310008677] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Varicocele can be defined as an abnormal tortuosity and dilatation of the veins of the pampiniform plexus. Contradictory results have been obtained from experimental animal models and a few clinical human studies on testicular arterial blood flow in varicocele. The purpose of this study was to determine the changes in testicular arterial blood flow parameters in patients with varicocele. MATERIAL AND METHODS A total of 62 patients with a clinical diagnosis of left varicocele and a scrotal vein with a diameter of > or = 3 mm on color Doppler ultrasonography were included in the study. A total of 44 fertile normal male volunteers served as controls. RESULTS Median testicular arterial blood flow and median flow rate in milliliters per minute per 100 g of testicular tissue were found to be significantly decreased in the patient group compared to the control group: blood flow, 1.42 and 2.00 ml/min; flow rate, 9.63 and 12.35 ml/min/100 g, respectively (p < 0.05). Positive correlations were found between sperm concentration and left testicular artery blood flow (p < 0.05) and between left testicular volume and testicular artery blood flow (p < 0.05). CONCLUSIONS Testicular arterial blood flow was found to be significantly decreased in men with varicocele. This may be a reflection of the impaired microcirculation. Following decreased testicular arterial blood flow, impaired spermatogenesis may result from defective energy metabolism in the microcirculatory bed.
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Affiliation(s)
- Serdar Tarhan
- Department of Radiology, Medical Faculty, Celal Bayar University, Manisa, Turkey.
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43
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Affiliation(s)
| | - Paul Seville
- From the Children’s Hospital of Buffalo, Buffalo, New York
| | - Julian Wan
- From the Children’s Hospital of Buffalo, Buffalo, New York
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Spyropoulos E, Borousas D, Mavrikos S, Dellis A, Bourounis M, Athanasiadis S. Size of external genital organs and somatometric parameters among physically normal men younger than 40 years old. Urology 2002; 60:485-9; discussion 490-1. [PMID: 12350491 DOI: 10.1016/s0090-4295(02)01869-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To estimate the sizes of the external genital organs in physically normal adult males younger than 40 years old, as well as to correlate the resulting values with age and a number of somatometric parameters, to provide data that could be clinically applicable by the practicing urologist. METHODS Fifty-two physically normal men, 19 to 38 years old, underwent tape measurements of penile dimensions in the flaccid-stretched state (total, shaft, glanular lengths), penile shaft volume calculation, and ultrasonographic testicular volume estimation. The resultant values were correlated with age, height, weight, body mass index, waist/hip ratio, and index finger length. RESULTS The mean testicular volume was 16.9 +/- 4.7 cm(3), with the right testis (17.5 +/- 5.8 cm(3)) measuring slightly larger than the left (15.85 +/- 4.9 cm(3); P = not significant). The mean total penile length was 12.18 +/- 1.7 cm, the mean penile shaft length was 7.76 +/- 1.3 cm, the mean glanular length was 4.4 +/- 0.4 cm, and the mean penile shaft volume was 46.5 +/- 17.2 cm(3). Among the various correlations performed, the penile lengths (total, shaft, glanular) to index finger length (P <0.05) and to penile shaft volume (P <0.001) were statistically significant. CONCLUSIONS Data on the size of the external genital organs among physically normal young adult men were provided and a novel formula for penile shaft volume calculation was proposed. Age and somatometric parameters were not associated with the size of the genitalia, excluding the index finger length, which correlated significantly with the dimensions of the flaccid, maximally stretched, penis.
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Stavropoulos NE, Mihailidis I, Hastazeris K, Moisidou R, Louka G, Filiadis I, Zouma E, Danella M, Kalomiris P. Varicocele in schoolboys. ARCHIVES OF ANDROLOGY 2002; 48:187-92. [PMID: 11964211 DOI: 10.1080/01485010252869270] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
This study was conducted to examine the effect of height and weight on the incidence of varicocele in schoolboys aged 5-16 years and the impact of varicocele on testicular size. Genital stage, height, weight, varicocele grade, and testicular size were recorded for 3047 school boys who were clinically examined while standing by a specialist in urology. Left varicocele was detected in 98 of the boys who were all aged 9-16 years. The mean weight of boys with and without varicocele was 42 kg (95% confidence interval [CI] 40-44 kg) and 47 (95% CI 47-47 kg), respectively (p =.00). There was no difference in mean height between the two groups nor in left and right testicular volume. Although 6 boys with varicocele had a left testicular volume > or =2 mL less than right, there were also 7 boys of comparable age who had a left testicular volume > or =2 mL larger than right. The incidence of varicocele in Greek adolescents is low. Boys with varicocele weighed significantly less but there were no significant differences in height or left versus right testicular volumes. In the light of these observations, the use of left testicular hypotrophy (> or =2 mL compared with the right testicle) should be reconsidered as an indicator for varicocele-induced damage of the testicle in this age group.
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Affiliation(s)
- N E Stavropoulos
- Department of Urology, G. Hatzikosta General Hospital, Ioannina, Greece.
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Alqahtani A, Yazbeck S, Dubois J, Garel L. Percutaneous embolization of varicocele in children: A Canadian experience. J Pediatr Surg 2002; 37:783-5. [PMID: 11987101 DOI: 10.1053/jpsu.2002.32287] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND/PURPOSE The importance of early treatment of varicocele, to prevent testicular damage is widely accepted. Surgical treatment of varicocele has been the standard method of therapy, but recently a less invasive procedure was introduced and utilized mostly in Europe. The authors reviewed their experience with percutaneous embolization and sclerotherapy to assess the feasibility and outcome of this approach in children. METHODS The authors conducted a retrospective study including all patients who underwent percutaneous embolization and sclerotherapy for varicocele in the authors' institutions for the last 10 years. Clinical data, investigation, pre and postintervention management, and the technique of the procedure, including sedation and anesthesia when needed, were collected from the charts. Follow-up was obtained from the chart or by phone. RESULTS Between 1991 and 2001, 41 patients underwent 43 percutaneous interventions. The median age was 14 years (range, 10 to 20 years). All but 2 were injected with a sclerosing agent; in 26 cases coils were added. All procedures except one were done under local anesthesia with sedation. Only 2 patients were admitted overnight, and 5 patients had minor complications. The average procedure time was 55 minutes. Follow-up data were obtained in 39 patients (95%), with a mean follow-up of 22 months. A total of 89.1% of those who were injected have satisfactory results (cured or improved) without the need for further procedures. Six patients required surgery post-percutaneous procedure, 4 because of persistent or recurrent varicocele and 2 because of technical failure. CONCLUSIONS Percutaneous embolization is a safe and effective treatment of varicocele in children with technical success in 95% and therapeutic success in 89%. It now is the authors' first treatment modality for this disease.
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Abstract
At present, it is reasonable to counsel all patients, as well as family members of patients, who have a palpable varicocele about the long-term risks for impaired fertility. Currently, no one can predict with absolute certainty if any adolescent with a varicocele will be at risk for future infertility. Based on existing data, however, it is not reasonable simply to ignore the potential for such a problem until infertility becomes an issue because by that time the chance for reversibility may be lost. It is important to present a balanced discussion because the majority of men with a varicocele will be fertile, and no one is suggesting that all men with a varicocele undergo surgical treatment. Current recommendations for repair are based on the findings of impaired testicular growth and/or spermatogenesis. With early evaluation and selective treatment, however, we should be able to reduce the potential for future fertility problems significantly in adolescents with a varicocele.
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Affiliation(s)
- Evan J Kass
- Division of Pediatric Urology, William Beaumont Hospital, 3601 W. Thirteen Mile Road, Royal Oak, MI 48073, USA.
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Paltiel HJ, Diamond DA, Di Canzio J, Zurakowski D, Borer JG, Atala A. Testicular volume: comparison of orchidometer and US measurements in dogs. Radiology 2002; 222:114-9. [PMID: 11756714 DOI: 10.1148/radiol.2221001385] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare the accuracy and precision of orchidometer and ultrasonographic (US) measurements of testicular volume in a canine model. MATERIALS AND METHODS Volume measurements of 18 canine testes were obtained by using Prader and Rochester orchidometers. Testes were scanned with two linear-array US transducers with imaging frequencies of 6-13 MHz and 5-10 MHz. For each transducer, testicular volumes were calculated by using three formulas: length (L) x width (W) x height (H) x 0.52, L x W(2) x 0.52, and L x W x H x 0.71. Testes were weighed following bilateral orchiectomies. True testicular volume was determined by using the formula volume = weight/density. Paired t tests were used to assess whether mean measurement biases differed significantly from zero. The relationship between true and measured volume was evaluated with a linear regression model. RESULTS US volume measurements demonstrated lower variability and better linear fit compared with orchidometry (R(2) = 0.75-0.90 vs R(2) = 0.14-0.38). The formula L x W x H x 0.71 had the smallest mean bias relative to true volume with use of either transducer over the entire volume range. CONCLUSION US methods of testicular volume measurement are more accurate and precise than orchidometry. The formula L x W x H x 0.71 provides a superior estimate of testicular volume and should be used in clinical practice.
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Affiliation(s)
- Harriet J Paltiel
- Department of Radiology, Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA.
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