Varicocele Size Research Articles

PD09-11 VEIN DIAMETER ON ULTRASOUND AS PREDICTOR OF SEMEN PARAMETER IMPROVEMENT AFTER VARICOCELECTOMY

You have accessJournal of UrologyCME1 May 2022PD09-11 VEIN DIAMETER ON ULTRASOUND AS PREDICTOR OF SEMEN PARAMETER IMPROVEMENT AFTER VARICOCELECTOMY Leon Telis, Alan Paniagua Cruz, Kirolos Meilika, Hira Chaudhry, Michael Huaman, and Boback M. Berookhim Leon TelisLeon Telis More articles by this author , Alan Paniagua CruzAlan Paniagua Cruz More articles by this author , Kirolos MeilikaKirolos Meilika More articles by this author , Hira ChaudhryHira Chaudhry More articles by this author , Michael HuamanMichael Huaman More articles by this author , and Boback M. BerookhimBoback M. Berookhim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002535.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Clinical presence and grade of varicocele has been associated with the degree of spermatogenic response to varicocelectomy. There have been no objective pre-operative factors that have been found to correlate with spermatogenic improvement post-varicocelectomy. We aim to determine whether preoperative venous diameter on ultrasound may predict semen parameter improvement post-varicocelectomy. METHODS: We performed a retrospective chart review of a single-surgeon cohort of patients undergoing microsurgical varicocelectomy to assess the impact of pre-operative ultrasound varicocele diameter on changes in semen analysis. Sonography was performed at local centers with experience in scrotal Doppler sonography. Maximal internal spermatic vein diameters were reported. Paired t-test and Wilcoxon signed-rank test were used to analyze changes in pre- and post-operative semen parameters. Paired t-test was used to further analyze changes in pre- and post-operative semen parameters among unilateral vs bilateral varicocelectomy. Statistical significance was defined as p <0.05. Kendall rank coefficient was performed to assess correlation of varicocele clinical grade and vein diameter on ultrasound. RESULTS: The last 180 consecutive patients who underwent subinguinal microsurgical varicocelectomy were evaluated. Median age of patients was 32 years (range 19-57). 56 patients with available post-operative semen analyses underwent bilateral repair and 49 patients underwent unilateral repair. Mean time from surgery to post-operative semen analysis was 5.4 months. Men who underwent varicocelectomy with vein diameter >3.5 mm had a significant improvement in sperm concentration. Improvement in sperm motility and morphology was also noted in this cohort and approached statistical significance. Those with varicoceles <3.5 mm did not demonstrate an improvement in semen parameters. Significant improvement in semen concentration and morphology was noted among patients undergoing bilateral repair. There was a statistically significant association between clinical and radiographic varicocele size (tau = 0.391, p <0.001). CONCLUSIONS: We identified an improvement in semen analysis parameters after varicocele repair in men with clinical varicoceles with venous diameter >3.5 mm on ultrasound. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e181 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leon Telis More articles by this author Alan Paniagua Cruz More articles by this author Kirolos Meilika More articles by this author Hira Chaudhry More articles by this author Michael Huaman More articles by this author Boback M. Berookhim More articles by this author Expand All Advertisement PDF DownloadLoading ...

Reprint of: Varicocele Size And Results of Varicocelectomy in Selected Subfertile Men with Varicocele

Reprint of: Varicocele Size And Results of Varicocelectomy in Selected Subfertile Men with Varicocele

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

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.

Active Surveillance of the Adolescent with Varicocele: Predicting Semen Outcomes from Ultrasound

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. 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. 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). 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.

Grade 3 Varicocele in Fertile Men: A Different Entity

Although varicocele size has an inverse relationship with baseline semen parameters and a direct relationship with seminal reactive oxygen species in infertile patients, to our knowledge the effect of varicocele grade in fertile men is unknown. We evaluated the impact of varicocele grade on seminal parameters, testicular size and seminal reactive oxygen species in fertile men. We prospectively evaluated 194 men from July 2004 to April 2010. Of the men 156 were fertile and classified by presence of varicocele. A total of 38 infertile patients with varicocele as the only identifiable cause of infertility comprised the control group. Physical examination, semen parameters and seminal reactive oxygen species were compared between the groups. Of 156 fertile men 43 (24.3%) had clinical varicocele, which was grade 1 to 3 in 22, 11 and 10, respectively. The remaining 113 men (72.7%) had no varicocele. Infertile men had smaller testes, decreased semen parameters and higher seminal reactive oxygen species than the fertile groups. Testicular size, reactive oxygen species and semen parameters did not differ between fertile men with vs without varicocele. Fertile men with varicocele grade 3 had higher seminal reactive oxygen species than those with lower grade varicocele. As varicocele grade increased, seminal reactive oxygen species increased and sperm concentration decreased. Although fertile men have more efficient defense mechanisms to protect against the consequences of varicocele on testicular function, these mechanisms may not be sufficient in those with varicocele grade 3. Further research is needed to clarify whether they are at increased risk for future infertility.

Predictors of Sperm Recovery and Azoospermia Relapse in Men With Nonobstructive Azoospermia After Varicocele Repair

In this study we determined the recoverability and sustainability of motile sperm in semen of men with nonobstructive azoospermia after varicocelectomy as related to different variables. Men with documented infertility for more than 1 year, with nonobstructive azoospermia and clinically palpable varicoceles were included in this prospective noncontrolled study. Participants underwent simultaneous subinguinal microsurgical varicocelectomy and testicular biopsies. Preoperative as well as initial and late followup semen analyses were performed. Outcomes of sperm recovery and relapse of azoospermia were correlated with the variables of patient age, infertility duration, varicocele grade, laterality, follicle-stimulating hormone, testicular volume and testicular histology. The study included 31 men with a mean ± SD age of 34.9 ± 8.7 years and mean followup of 19.3 ± 3.3 months. Hypospermatogenesis, late maturation arrest, early maturation arrest and Sertoli-cell-only were observed in 13, 6, 2 and 10 patients, respectively. Overall, sperm recovery was evident in 10 of 31 (32.3%) patients (persistent recovery 19.4%, intermittent recovery 6.5%, relapse 6.5%). Sperm were recovered in patients with hypospermatogenesis (7 of 13, 53.8%) and late maturation arrest (3 of 6, 50%). No sperm were recovered in those with early maturation arrest or Sertoli-cell-only. Among the variables only histological patterns demonstrated a significant correlation with recovery (rho = 0.504, p = 0.004). None of variables was significantly correlated with relapse. Bilateral varicocele repair demonstrated a strong yet nonsignificant negative correlation with relapse (rho = -0.612, p = 0.06). Varicocelectomy could recover motile sperm in men with nonobstructive azoospermia, palpable varicoceles and hypospermatogenesis or late maturation arrest. No sperm was recovered with early maturation arrest or Sertoli-cell-only. Recovery might be persistent or intermittent, or involve relapse of azoospermia. Testicular histology was the sole parameter significantly correlated with recovery and no predictors of relapse could be identified. This prognostic role of testicular biopsy is imperative in couple counseling.

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Varicocele is a common pathology among the whole male population, regarding 10%-35% of healthy adult men and adolescents. There is a clear evident relationship between varicocele and subfertility/infertility; however, whether varicocele treatment improves fertility is highly debated among the international literature. Several studies have attempted to relate many patient parameters with differences in sperm quality improvement. The most frequently studied parameters are varicocele size, numbers of veins ligated, age of patients at intervention, and the clinical or only instrumental evidence of varicocele before its correction. A clear correlation between pathogenetic mechanisms of testicular damage and some preoperative parameters predicting a better outcome is still lacking. Our study's goal was to analyze the main factors that can help urologists in selecting patients who will probably undergo a better improvement in seminal parameters after varicocele sclerotization. The main factors analyzed were varicocele grade and age of patients. The importance of the grade is its strict connection with varicocele pathogenesis, whereas the analysis on patient age is helpful in deciding whether treatment on older patients loses its therapeutic outcome on their fertility. Our results clearly showed a significant improvement in semen quality by treating all patients, and their age was not related to any difference. The only strongly significant parameter showing a clear difference in spermatic results was the presence of renospermatic venous basal reflow, identified with varicocele grades 4 and 5. Therefore, we recommend the treatment of varicocele for infertile patients of every age, even those aged more than 40 years, especially if their varicocele is fourth or fifth grade using Sarteschi classification. Editorial CommentUrologyVol. 75Issue 5PreviewThis is a prospective study using patients as their own control to analyze the predictive significance of renospermatic basal reflow on color Doppler ultrasound on sperm concentration, motility, and morphology. A total of 113 men were selected based on the presence of a unilateral left varicocele. The appropriate exclusion criteria were used. Renospermatic basal reflow was categorized using the classification schema of Sarteschi, which assesses internal spermatic vein size and level of reflow in the supine and standing position with and without Valsalva. Full-Text PDF

Initial experience with percutaneous selective embolization: A truly minimally invasive treatment of the adolescent varicocele with no risk of hydrocele development

Postoperative hydrocele development is a frustrating complication of varicocele surgical repair. To avoid this complication, we began to offer percutaneous embolization as a treatment option. We present our initial experience with this technique. A retrospective review of all patients who underwent percutaneous embolization and sclerotherapy of a varicocele at our institution was performed. There were 27 patients with a mean age of 16 years (range 13-19 years). Indications included pain (48%), varicocele size (30%) and persistent testicular asymmetry (22%). Four patients had experienced failure of a previous surgical repair. Follow-up data were available for 21 patients (mean 9 months). The varicocele resolved in 19 patients (91%) with no evidence of hydrocele formation in any of the boys. There was resolution of pain in all patients for whom this was the indication for the procedure. In the two failures, access to the lower spermatic vein was not possible owing to the number and tortuosity of the vessels. Percutaneous embolization and sclerotherapy represent a truly minimally invasive treatment with low morbidity, minimal pain and rapid recovery. In our early experience, since lymphatic channels are completely avoided, there appears to be no risk of hydrocele formation.

Testicular Catch-up Growth After Varicocelectomy: Does Surgical Technique Make a Difference?

Catch-up growth of the affected testis in adolescents after varicocele repair has been well documented. Many investigators have found evidence that testicular hypotrophy related to varicocele can be reversed by early intervention. The aim of this study was to analyze the testicular catch-up growth rate in pediatric patients, correlating it with patient age at surgery, varicocele size, procedures used, and semen quality. Between March 1990 and September 2006, a total of 465 varicocelectomies were performed at our department. We evaluated the mean testicular volume before and after varicocelectomy in patients aged 9-14 years. Two procedures were used: laparoscopic artery-preserving varicocelectomy (group 1) and open inguinal microscopic artery-preserving varicocelectomy with a venous-venous bypass (group 2). The testicular volume was measured before and after surgery using ultrasonography, and the mean testicular catch-up growth was recorded. Although the overall catch-up growth rate for both groups was 80%, after 18 months, only 45% of patients in group 1 and 34% of patients in group 2 had equal bilateral testicular volume. None of these procedures showed a statistically significant correlation with age at surgery, varicocele size, or catch-up rate. The semen analysis results did not show statistically significant differences between the 2 groups. Although 80% of patients demonstrated testicular catch-up, with a different distribution depending on the procedure type used but without statistically significant differences, only 32% of patients had complete and real testicular volume catch-up.

Serum inhibin B concentration as a prognostic factor for prediction of sperm retrieval in testis biopsy of patients with azoospermia.

This study was conducted to determine if serum inhibin B concentration can predict spermatogenesis in azoospermic infertile men. This cross-sectional study included 70 patients with male-factor infertility referred to Alvand and Vali-e-Asr Infertility Centers, Tehran, Iran. All patients had azoospermia. Standard evaluation consisted of history and physical examination with extreme attention to sexual history and testis examination including testis size, consistency, and presence of varicocele. Laboratory evaluation done for all cases consisted of FSH, testosterone, LH, prolactin, and inhibin B. Testis biopsy was performed in all cases with acceptable testis volume and FSH. The mean inhibin B level was compared in groups with positive and negative sperm retrieval. The mean+/-SEM age of 70 azoospermic patients was 32.1+/-6.2 (range: 20 - 50) years. All couples had primary infertility with a mean+/-SEM duration of infertility of 74.3+/-7.7 months. The mean+/-SEM testicular volume was 10.14+/-0.75 mL. The mean+/-SEM FSH and LH levels were 17.55+/-1.68, and 11.33+/-0.99 mIU/mL, respectively. The mean+/-SEM serum prolactin and testosterone levels were 308.77+/-17.35 and 5.45+/-0.91 ng/dL, respectively. The mean+/-SEM serum inhibin B concentration was 138.23+/-28.58 (range: 15 - 1500) pg/mL. Sperm was not retrieved in 82% of the patients; in 13% of the cases, biopsy revealed spermatogenesis. The mean+/-SEM serum FSH level of positive and negative groups was 9.78+/-2.13 and 22.56+/-2.46 mIU/mL, respectively (P<0.05). The mean serum LH, prolactin, and testosterone levels were not statistically different between the two groups. The mean+/-SEM serum inhibin B was 129+/-45.46, and 158.93+/-47.24 pg/mL in positive and negative groups, respectively (P>0.05). Inhibin B concentration is not an appropriate predicting factor for testicular spermatogenesis.

Sperm count and sperm motility in incidental high-grade varicocele

One hundred twenty-four otherwise healthy men with suspected high-grade varicocele, comprised of 28 patients with grade 2 and 96 with grade 3 varicocele, were referred to us by their primary care providers to determine their exact grade so that they could be exempted from the compulsory armed force service if they had grade 3 varicocele. In the grade 2 and grade 3 groups, mean sperm concentration and mean sperm motility were 80.89 million per milliliter (SD, 38.98 million/mL; median, 74.5 million/mL; range, 22-210 million/mL) and 78.77 million per milliliter (SD, 41.34 million/mL; median, 77 million/mL; range, 0-223 million/mL) and 58.39% (SD, 13.7%; median, 60%; range, 22-75%) and 60.31% (SD, 16.93%; median 65%; range, 0-80%), respectively, with no statistically significant differences between the two groups, no patient with infertility as a complaint during a 20-month period, and no patient with sperm concentrations of <20 million/mL, but with six patients with sperm motilities <50%. In summary, by far the great majority of patients with high grade varicocele have more than normal sperm output. Higher grades of varicocele are not associated with more pronounced deleterious effects on sperm concentration and percentage motility. Incidentally diagnosed high-grade varicocele is not a progressive condition, and almost all patients retain normal semen quality, at least over a period of 20 months.

P-648: Clinical, sonographic, and intra-operative assessment of varicoceles: Does the data correlate?

There are no prior studies correlating clinical grade, pre-operative sonographic vein size, and intra-operative vein size measured at the time of microsurgical subinguinal varicocelectomy. The purpose of this study was to compare varicocele grade and pre-operative sonographic data with intra-operative vein size at the time of varicocelectomy. This is a prospective, non-randomized review of 64 consecutive men who underwent microsurgical subinguinal varicocelectomy. A total of 64 consecutive men (mean age 34.5 yrs) were enrolled in this study. Twenty-six underwent unilateral microsurgical subinguinal varicocelectomy, of which 23 were left and 3 right. The remaining 38 patients underwent bilateral varicocelectomy for a total of 102 varicocele units. Varicoceles were clinically graded I-III. Pre-operatively, 53 varicocele units had sonographic size available. At surgery, the diameter of the largest internal spermatic vein at the external inguinal ring was measured using a sterile micro-ruler prior to ligation. For clinical grade I varicoceles, the mean sonographic size (n=15) was 2.7 mm (± 0.7), and the mean intra-operative size (n=20) was 3.5 mm (± 0.9). For grade II varicoceles, the mean sonographic size (n=21) was 2.4 mm (± 1.2), and the mean intra-operative size (n=42) was 3.7 mm (± 0.9). For grade III varicoceles, the mean sonographic size (n=17) was 3.5 mm (± 1.5), and the mean intra-operative size (n=40) was 5.2 mm (± 1.6). Using analysis of variance (ANOVA) with Scheffe multiple comparison adjustment, clinical grade was predictive of intra-operative vein size (p<0.0001). Intra-operative vein size for grade III varicoceles was significantly larger than that of grades I and II varicoceles (p<0.0001). There was no significant difference in intra-operative size between grades I and II (p=0.78). Clinical grade was also predictive of sonographic vein size (p=0.03). However, this correlation was only significant between grades II and III varicoceles after post-hoc adjustment (p=0.03). There was no significant linear correlation between sonographic and intra-operative vein size (r2 = 0.12, p = 0.38). Clinical varicocele grade is predictive of intra-operative vein size. Clinical grade is also predictive of pre-operative sonographic varicocele size, although this difference is only significant between grades II and III varices. There was no significant correlation between pre-operative sonographic vein size and intra-operative vein size. Sonographic and intra-operative vein size may be useful additional predictors of varicocelectomy outcome.

O-117: Does varicocele size exert deleterious effect on spermatogenesis in adolescents?

Varicocele is a leading cause of secondary infertility, and may be present in over 40% of infertile men. Its effects are long-term and progressive and may lead to a decrease in sperm concentration, morphology, and motility. It has also been shown that varicocele may cause alterations even in adolescents, which suggests that a varicocele may alter semen quality even during its initial stages. On the other hand, it is not known if the size of the varicocele will determine extension of damage to the testicular germ cells.

Surgical Repair of Varicocele: a Comparative Study of the Retroperitoneal Approach of Palomo, the Modified Palomo Technique and the Microsurgical Inguinal Approach of Ivanisseivich's Technique

Purpose: We wanted to compare our experience and results with three different methods of treatment for varicocele. Materials and Methods: Between January 1995 and December 2005, 154 patients with varicocele were retrospectively assigned into three groups according to the method of treatment. Group 1 included 73 patients who were treated by the retroperitoneal approach of Palomo's technique. Group 2 consisted of 37 patients who were treated by the retroperitoneal approach and who also underwent the internal spermatic artery preserving technique, and in group 3, 44 patients were treated by the microscopic inguinal approach of Ivanissevich's technique. We analyzed the operation time, recurrence, complications, the effect of surgical treatment and the results according to the surgical techniques. Results: The mean operative time of group 3 was significantly longer among the three groups. The recurrence rate at follow-up was not significantly different among the three groups. The recurrence rate increased progressively with the increase of varicocles size from grade I to grade III for all the groups. The overall incidence of postoperative complications was significantly lower among the patients in group III. The postoperative spermiogram showed an increase in motility and sperm count for all the groups. There were no differences in the three techniques for resolution of pain, the duration of recovery and the spermiogram results. Conclusions: There was no significant difference in the rate of relapse after the surgery between the three different treatment techniques, and the factors involved in relapse were more related to the size and severity of the varicocele. Microsurgical varicocelectomy had a disadvantage of a prolonged operation time. However, there was a low rate of postoperative complications for all three techniques. (Korean J Urol 2006;47:1086-1092)

Increased seminal reactive oxygen species levels in patients with varicoceles correlate with varicocele grade but not with testis size

Increased levels of reactive oxygen species (ROS) are associated with clinical varicoceles; however, its correlation with varicocele grade and testis size is unknown. In our study, seminal ROS levels showed significant correlation with left varicocele grade and significantly elevated seminal ROS levels were seen in men with left varicocele grade 2 and 3 compared to grade 1.

Testicular Growth Arrest and Adolescent Varicocele: Does Varicocele Size Make a Difference?

We assessed whether testicular growth arrest is related to varicocele size in adolescents. We also determined whether adolescents with a varicocele and testes of equal size treated nonoperatively are at significant risk for growth arrest and, if so, whether this risk is related to varicocele size.We retrospectively reviewed the records of boys with a varicocele. Testis volume was measured with calipers and computed into cc as (length x width x breadth) x 0.521. Testicular growth arrest was defined as left testis at least 15% smaller than the right testis. Varicocele size was graded 1-barely palpable, 2-palpable but not visible, 3a-visible and, 1 to 1.5 times the size of the ipsilateral testis, 3b-1.5 to 2 times the size of the ipsilateral testis and 3c-greater than 2 times the size of the ipsilateral testis. Boys with a grade 1 varicocele and those treated with previous inguinal or testicular surgery were excluded from study. Repair was recommended for testicular growth arrest or discomfort. Data were analyzed with chi-square and Fisher's exact test.The records of 124 boys 7 to 18 years old (mean age 13) with a varicocele were reviewed. Seven patients were excluded from analysis, yielding a total of 117 boys. Testicular growth arrest was observed at initial visit in 10 of 33 (30.3%) grade 2, 18 of 37 (48.6%) grade 3a, 14 of 31 (45.2%) grade 3b and 6 of 16 (37.5%) grade 3c cases (p not significant), or a total of 38 of 84 (45.2%) grade 3 cases (p <0.01) plus grade 2. Followup ranged from 1 to 5 years. Of the cases of equal sized testes at presentation growth arrest was observed in 3 of 16 (18.8%) grade 2, 2 of 11 (18.2%) grade 3a, 4 of 14 (28.6%) grade 3b and 3 of 9 (33.3%) grade 3c (p not significant), or a total of 9 of 34 (26.5%) grade 3 cases (p not significant) plus grade 2. Overall, testicular growth arrest was found in 13 of 33 (39%) grade 2 and 47 of 84 (56%) grade 3 varicoceles (p <0.01).Boys with a varicocele are at significant risk for testicular growth arrest, irrespective of varicocele size, and those with a grade 3 varicocele have a higher risk of testicular growth arrest than those with a grade 2 varicocele. Of boys with testes of equal size at diagnosis growth arrest is observed during adolescence in approximately 25% irrespective of varicocele size.

Experience with Varicoceles in Children and Young Adults

Experience with Varicoceles in Children and Young Adults

Multivariate analysis of parameters that predict response to microsurgical varicocele repair.

Multivariate analysis of parameters that predict response to microsurgical varicocele repair.

Effects of varicocele on male fertility.

Varicoceles are vascular lesions of the pampiniform plexus and are the most common identifiable abnormality found in men being evaluated for infertility. Despite the long history associated with varicoceles, there remains much controversy regarding their diagnosis and management. The purpose of this manuscript is to address three of the most pressing controversies: (i) the association of varicoceles with male infertility, (ii) whether varicoceles exert a progressive deleterious effect and (iii) the relationship of varicocele size and outcome following varicocele repair. The current literature is reviewed in an effort to answer these questions. Based upon this analysis, conclusions can be drawn regarding the best management of varicoceles in subfertile men, adolescents, young fertile men and men with subclinical varicoceles. Although there remain many controversies due to a paucity of data, there appears to be a significant difference between adults and adolescents with respect to a progressive deterioration of semen parameters and it is clear that subclinical varicoceles do not play a major role in male infertility.

COMPARATIVE ASSESSMENT OF PEDIATRIC TESTICULAR VOLUME: ORCHIDOMETER VERSUS ULTRASOUND

COMPARATIVE ASSESSMENT OF PEDIATRIC TESTICULAR VOLUME: ORCHIDOMETER VERSUS ULTRASOUND