1366 ACTIVE SURVEILLANCE OF THE ADOLESCENT VARICOCELE

Abstract

You have accessJournal of UrologyPediatrics: Andrology - Cryptorchidism & Varicoceles1 Apr 20121366 ACTIVE SURVEILLANCE OF THE ADOLESCENT VARICOCELE Matthew Christman, Thomas Kolon, Douglas Canning, and Stephen Zderic Matthew ChristmanMatthew Christman Philadelphia, PA More articles by this author , Thomas KolonThomas Kolon Philadelphia, PA More articles by this author , Douglas CanningDouglas Canning Philadelphia, PA More articles by this author , and Stephen ZdericStephen Zderic Philadelphia, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1750AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Varicoceles (Vx) are present in 15% of the normal male population and in approximately 40% of men presenting with infertility. Surgical intervention for Vx has been shown to improve semen analysis (SA) parameters and reduce the need for assisted reproductive technology. The optimum management of adolescents with Vx, however, is debated and unknown. We hypothesize that active surveillance of adolescent Vx will not be associated with a high prevalence of suboptimal SA. METHODS An IRB-approved retrospective cohort study of adolescents with a clinically detected varicocele was conducted. Patients were initially observed with serial exams and scrotal ultrasounds (ScrUS) evaluating testicular size and differential. To be included in the study patients must have undergone at least one ScrUS and one SA. Exclusion criteria included a potential confounding abnormality of the hypothalamic-pituitary testicular axis, treatment of a varicocele prior to collection of the SA, and an inadequate SA for analysis. SA was routinely collected in Tanner V individuals around the age of 18 years. Vx treatment was offered for the indications of pain, consecutive testicular volume differential > 20% on ScrUS, and/or consistent abnormal SAs. Abnormal SA was defined as total motile count (TMC) less than 20 million motile sperm per ejaculate. RESULTS A total of 70 patients were identified for surveillance. The mean age at presentation was 15.6 years. Patients were then followed an average of 3.1 years until they submitted a SA at age 18.7 years (range, 15.9–21.8). A total of 67% (47/70) had a low TMC. From the group with a low TMC, a second SA was obtained in 60% (28/47). The average TMC of these two samples remained low in 93% (26/28). A mean of 3.5 (median, 3) ScrUSs were obtained in each patient during the observed period. Length of follow-up did not correlate with a low TMC (p = 0.117). Surgical correction of Vx was performed in 19% (13/70). CONCLUSIONS There is a high prevalence of suboptimal SA in adolescents with a varicocele who are followed with active surveillance, contrary to our hypothesis. This suggests that Vx present during adolescence may have a greater adverse effect on ultimate spermatogenic potential than those identified later in adulthood — after the adolescent period of rapid testicular growth. A standardized algorithmic approach to active surveillance of adolescent Vx has been in place at our institution, however, a more aggressive stance on management of this entity is currently being developed. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byKolon T (2013) The Adolescent Varicocele—A Shakespearean Tragedy or Much Ado About Nothing?Journal of Urology, VOL. 189, NO. 6, (2024-2025), Online publication date: 1-Jun-2013. Volume 187Issue 4SApril 2012Page: e554 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Christman Philadelphia, PA More articles by this author Thomas Kolon Philadelphia, PA More articles by this author Douglas Canning Philadelphia, PA More articles by this author Stephen Zderic Philadelphia, PA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...