MP43-17 TO DO OR NOT TO DO TESTIS-DELIVERY-PROCEDURE DURING MICROSURGICAL SUBINGUINAL VARICOCELECTOMY PERFORMED ON PEDIATRIC PATIENTS

Abstract

INTRODUCTION AND OBJECTIVES: Semen analysis is the most representative assessment of fertility potential and thus indication for surgery of the adolescent varicocele. As there are known factors that may influence the reproducibility of the study, we sought to assess the variability of semen analyses in adolescents with varicoceles to assess whether one study is sufficient. METHODS: A retrospective analysis of all Tanner 5 adolescent males managed in a single center for varicoceles was performed. At least two semen analyses were performed within 2 months of each other. Clinical and demographic data were reviewed, as well as testicular size measured by sonography. Descriptive statistics, and paired ttests of absolute values and test for normal and abnormal findings (using 20 million sperm and 50% motility as cutoffs) were used to calculate statistical significance (p<0.05) for semen volume, sperm count, motility, and morphology. RESULTS: 66 males met the inclusion criteria. The mean age was 17.9 yrs (range 17-20), mean left testicular volume was 14.1 cc, 15.0 cc on the right, and an average total testicular volume of 33.8 cc. The varicocele size was Grade 2 (41%), Grade 3 (53%), and unavailable (6%). Comparison of the first and second semen analyses showed no difference between average sperm count (51.4 vs. 50.4 million) and morphology (10.5 vs. 10.1%). First test results did not predict motility (50.6% vs. 54.8%, p1⁄40.02) or semen volume (2.2 vs. 2.6 cc, p1⁄40.001). Findings from the first sperm count were able to accurately predict second sperm count. The majority of patients with normal first sperm counts had normal count on repeated exam. Only 1 patient with a normal sperm count had abnormal count on repeat test. Those who had abnormal results,10 were abnormal on repeat, while 15 were normal on repeat. Total testicular volume was associated with sperm count (p1⁄40.03). Semen parameters were not associated with left testicular volume, size discrepancy, or grade of varicocele. CONCLUSIONS: Repeated semen analyses show that sperm count is predicted by first test results, while motility and volume remain variable. Obtaining a second test is not supported in the setting of a normal first test, however it is warranted in the event of abnormal results. Total testicular volume is associated with sperm count and may serve as a surrogate when semen parameters are not available.