MP35-15 TRENDS IN DIAGNOSIS AND MANAGEMENT OF VARICOCELES AMONG U.S. MEN

Abstract

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation II1 Apr 2017MP35-15 TRENDS IN DIAGNOSIS AND MANAGEMENT OF VARICOCELES AMONG U.S. MEN Akanksha Mehta and Dattatraya Patil Akanksha MehtaAkanksha Mehta More articles by this author and Dattatraya PatilDattatraya Patil More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1105AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is considerable variation in clinical practice patterns with respect to assessment of testicular function in the setting of varicoceles, as well as techniques for varicocele repair. This study investigated trends in the management of varicoceles using a population-based dataset. METHODS We interrogated the inpatient and outpatient MarketScan Commercial Claims databases to identify all U.S. men diagnosed with varicoceles between 2009 and 2013, using CPT, ICD9, and HCPCS codes. Demographic and clinical characteristics of the men were analyzed, along with the types of procedures utilized for varicocele repair. Geographic variability in practice patterns for varicocele management was also reviewed. Unpaired t-tests and Chi-squared tests were used to evaluate differences in continuous variables, such as age, and categorical variables, such as geographic distribution, between men who did and did not undergo varicocele repair. SAS v.9.4 was used for all statistical analyses. Significance was set at p<0.05. RESULTS 25,792 men were diagnosed with a varicocele between 2009 and 2013. Average age at diagnosis was 32.5 years (SD 13.6). 20% of men were younger than 18 years of age at the time of diagnosis, and 53% were aged 18-39. 9,307 men (36%) underwent varicocele treatment, with either open (N=7,106), laparoscopic (N=1,072), or microsurgical (N=889) repair. Semen analyses were performed in 1,376 men (14.8%) before, and 2,484 men (26.7%) after varicocelectomy. Serum testosterone was evaluated in 3,361 men (13%) before, and 2,425 men (9.4%) after varicocelectomy. 18,285 men (70.9%) underwent a scrotal ultrasound within 6 months of their varicocele diagnosis, but 13,072 of them did not undergo varicocelectomy. Of the four U.S. Census Bureau regions, the varicoceles were most commonly diagnosed in the South (34% vs. 26% or less, p<0.001), whereas varicocelectomy was more likely to be performed in the Northeast (42% vs. 36% or less, p<0.001). There were no significant regional differences with respect to patient age or type of treatment utilized. CONCLUSIONS We found regional differences in the frequency of varicocele diagnosis and treatment. Overall, approximately one-third of men diagnosed with varicoceles underwent repair, but a microsurgical approach was utilized in only 9% of cases. The use of scrotal ultrasound around the time of varicocele diagnosis and treatment was common. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e463-e464 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Akanksha Mehta More articles by this author Dattatraya Patil More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...