Measurement Of Testicular Volume Research Articles

Inter and intra-rater reliability of accuracy of testicular volume evaluation: a simulation study

Background: The measurement of testicular volume is a practical and inexpensive method of pubertal staging in adolescents. Traditionally, volume is measured using orchidometers or calipers, the most widely used of which is the Prader Orchidometer. However, there is conflicting evidence of its use with regards to reliability in different hands. Objectives: To determine the accuracy of the Prader orchidometer in measuring testicular volume, by comparing the resultant measurement with the actual testicular volumes. Information on inter-observer and intra-observer variation was obtained for 16 investigators. Furthermore, the effect of factors such as clinical experience, gender and training in using an orchidometer on the accuracy of testicular volume measurement were investigated. Methods: A total of 16 investigators were asked to measure a range of 4 testicular volumes, attached via prosthesis to child-sized mannequins. The volume of each testis was measured independently using the Prader Orchidometer. A proportion of investigators also repeated testicular volume measurements, blinded by measurements obtained by other investigators. Results: The mean testicular volume measured by 16 examiners for 4 sizes at 20ml, 10ml, 5ml and 3ml. There were 4 male investigators and 12 female investigators. Fischer’s exact test found males to be significantly more accurate at measuring testicular volume than females (P =0.04). Chi-squared values were measured at each volume and showed no significant difference between those with clinical paediatric endocrine experience compared with those with no experience. Inter-observer reliability was measured using coefficient of variation due to our sample size of 16. This showed no significant difference between investigators measuring each testicular volume. However, it showed that larger volume testicles were more likely to be accurately measured compared to smaller volumes. Results showed that the 20ml volume had the smallest variability of 0.109 and 0.130 for right and left respectively ad the 3ml volume had a higher variation at 0.456 and 0.559 for right and left testicles respectively. Interestingly, variation was higher at all volumes in the left testicle. Furthermore, the 5ml volume has an unexpectedly low variability which may be attributed to its link with puberty and the need for endocrinologists to be skilledat identifying this particular volume due it’s clinical relevance. 7 people were trained vs 9 untrained in using orchidometers. Orchidometer training R20 A 3 B 10 C 5 D L20 A 3 B 10 C 5 D % accuracy trained 3/7 42.9 2/7 28.6 5/7 71.4 2/7 28.6 6/7 85.7 FE: 4/7 57.1 FE: 6/7 85.7 FE: 2/7 28.6 FE: %accuracy not trained 7/9 77.8 2/9 22.2 3/9 33.3 2/9 22.2 5/9 55.6 3/9 33.3 3/9 33.3 2/9 22.2 FE 0.302 1.00 0.315 1.00 0.308 0.615 0.060 1.000 Fischer’s exact: does having orchidometer training affect accuracy of results- not significant. Conclusion In conclusion, it was found that measurement of testicular volumes on paediatric testicular models is subject to great/little inter/intra-observer variation. The data suggests that there is a clinical need for formal training in testicular volume measurement as there is currently no established training in place. As a result, the innovative, custom-made testicular models for this study could have a role in simulation training as an educational tool.

Annual variations in resistive index (RI) of testicular artery, volume measurements and testosterone levels in bucks

The gonads of animals with sexual seasonality should change their metabolic requests throughout the year. In this study, we registered the variations of testicular volumes and serum testosterone levels in three Sarda bucks (Capra Hircus) and characterized the blood flow in the testicular artery by Doppler Ultrasonography, in order to shed light onto the type of relation between these parameters. After a 12-month study we observed that testicular volumes and testosterone levels show a typical seasonal variation with a maximum volume of testicular parenchyma recorded in September (116.06 ± 25.22 ml) while testosterone reached its peak in December (620.43 ± 192.87 ng/dl). Blood supply and resistivity seem to follow the changes in the parenchyma according to the functional activity, and the lowest resistivity values were observed in September (0.73 ± 0.02). An inverse U-shape best describes the relationship between testicular volume and testosterone levels (p < 0.05). This is the first report showing the changes in the blood supply to the testicular parenchyma of the buck throughout the year.

Pediatric andrology: the andrological patient from infancy to adulthood. Prevention interventions: how and when

Sonography, a non-invasive, quick method without biological impact on the gonad, has greatly improved the diagnostic possibilities; it is the gold standard for the male genital system (gonads and genito-urinary tract) and in fact has oriented the prevention interventions [1]. It recognizes almost 100% of scrotal lesions and their solid, liquid or complex nature. It has allowed to overcome the limits of traditional diagnostic methods for gonads like palpation, transillumination, and the Prader orchidometer for volumetric assessment. In fact, compared to this, sonography allows a more accurate volume measurement, expecially in small testicles; a correlation between measurements made with the orchidometer and those made with ultrasounds was found only for testicular volumes over 4 cc. [2]. Measurement of testicular volume is a fundamental element in pediatric andrology for evaluating puberty onset and progression. Furthermore, the sonographic exam is one of the best tools for assessing testicular pathologies like torsion, undescended testis, varicocele and in general in pathologies involving male genitalia; these cases can show significant variations of testicular volume. Testicular growth restriction may have relevant clinical implications for future testicular function [3]. The limits of traditional tools, like the orchidometer or the ruler for the measurement of pre-puberal testicle, are easy to identify: - The smallest pearl in Prader orchidometer is 1 ml, while sonography allows to make measurements in the first years of life (0,44 ml ± 0,03); - Orchidometer and ruler are known for overestimating testicular volume because they measure not only the didymus but also the epididymis (which in the first childhood is relatively big, compared to total testicular volume) and the scrotal tissues. Testicular volume is related to many reproductive endocrine parameters; therefore, a measurement of testicular volumes with a reliable method is appropriate, because any scrotal anomaly can influence testicular growth, and should be detected and treated as soon as possible. Moreover, andrological sonography is a first choice exam for male genitalia pediatric pathologies like acute scrotum, where diagnosis and clinical evaluations are particularly difficult. For example, during a suspected testicular torsion, a measurement made with a high resolution ultrasound machine by an expert examinator allows to reach a sensibility of 98% and a specificity of 99%, like scintigraphy and MRI with contrast medium. The sonographic study of the testicular region has absolute indications and relative indications. Absolute indications: difficult/inadequate objective clinical examination (sore and/or swelling testis, suggesting an acute scrotum; testicular torsion, trauma, undescended testis) or suspected testicular mass [4].

Diagnostic accuracy of physical examination compared with color doppler ultrasound in the determination of testis size and varicocele diagnosis

To evaluate the accuracy of physical examination on the diagnosis and grading of varicocele and on testicular volume measurement comparing to ultrasonographic assessment. Varicocele treatment should be offered to patient with palpable varicocele, provided it is associated with infertility. Also, varicocele should be repaired in patients with testicular growth impairment. Therefore, physical examination is the most important parameter to deselect men with subclinical varicocele or testicular size alteration to undergo treatment, as shown by the equivocal beneficial effect of such interventions in such cases.

The Correlation between Ultrasound Testicular Volume and Conventional Semen Parameters in Albanian Subfertile Males

OBJECTIVE: The study is conducted to evaluate the relationship between testicular volume measured by ultrasound and conventional sperm parameters (volume, concentration, total count, motility and morphology) in Albanian subfertile males and to determine a normal limit value of the testicular volume.MATERIALS AND METHODS: A total of 500 males were observed for this study. The testicular volumes of all subjects were measured by ultrasonography. The semen samples were collected by the process of masturbation after 3-5 days of ejaculatory abstinence and were analyzed according to WHO criteria 2010.RESULTS: Testicular volume has a strong positive correlation with sperm count, total count and motility and a positive correlation with semen volume.CONCLUSION: Testicular volume has a direct correlation with semen parameters and the critical total testicular volume indicating normal testicular function is approximately 26.6 ml (the mean testicular volume 13.3 ml). The measurement of testicular volume can be helpful for assessing fertility at the initial physical examination.

The Correlation between Ultrasound Testicular Volume and Conventional Semen Parameters in Albanian Subfertile Males

OBJECTIVE: The study is conducted to evaluate the relationship between testicular volume measured by ultrasound and conventional sperm parameters (volume, concentration, total count, motility and morphology) in Albanian subfertile males and to determine a normal limit value of the testicular volume.MATERIALS AND METHODS: A total of 500 males were observed for this study. The testicular volumes of all subjects were measured by ultrasonography. The semen samples were collected by the process of masturbation after 3-5 days of ejaculatory abstinence and were analyzed according to WHO criteria 2010.RESULTS: Testicular volume has a strong positive correlation with sperm count, total count and motility and a positive correlation with semen volume.CONCLUSION: Testicular volume has a direct correlation with semen parameters and the critical total testicular volume indicating normal testicular function is approximately 26.6 ml (the mean testicular volume 13.3 ml). The measurement of testicular volume can be helpful for assessing fertility at the initial physical examination.

Adult testicular volume predicts spermatogenetic recovery after allogeneic HSCT in childhood and adolescence.

Testicular dysfunction and infertility are of major concern in long-term survivors after allogeneic hematopoietic stem cell transplantation (HSCT). This study assesses predictive factors for very long-term testicular recovery after allogeneic HSCT in childhood and adolescence. Testicular volume, sperm production and long-term need of testosterone substitution were evaluated among 106 male survivors transplanted at Huddinge and Helsinki University Hospitals from 1978 through 2000, at a mean age of 8 ± 4.6 years (range 1-17). A mean ± SD of 13 ± 4.8 years (range 4-28) had elapsed since their HSCT and the mean age of the participants was 22 ± 6.0 years (range 12-42). An adult testicular volume was recorded in 74 patients at a mean age of 19 ± 3.3 years (range 14-36). Recipients conditioned with busulfan-based regimens or regimens containing only cyclophosphamide had significantly larger adult testicular volumes (mean volume 18 ml and 16 ml vs. 9 ml, P < 0.00001, respectively) and lower serum levels of FSH (mean 9 IU and 5 IU vs. 19 IU, P < 0.01 and 0.001, respectively) compared to those conditioned with total body irradiation (TBI). Multivariate analysis demonstrated that a non-leukemia diagnosis (P < 0.01) and adult testicular volume ≥ 15 ml (P < 0.03) positively impacted spermatogenetic recovery. A larger adult testicular volume, normal serum levels of FSH and spermatozoa detected in a majority of seminal fluids after busulfan-based or cyclophosphamide conditionings suggest very long-term recovery of spermatogenesis after chemotherapy-based regimens. A simple measurement of adult testicular volume may help predict spermatogenetic potential among pediatric HSCT survivors.

Adolescent varicocelectomy: does artery sparing influence recurrence rate and/or catch-up growth?

The prevalence of varicocoeles is 15% in the general adolescent and adult male population and in 35-40% of men evaluated for infertility. While varicocelectomy can be performed using various methods and techniques, the laparoscopic approach allows for clear visualization of the testicular artery and lymphatics. Amongst urologists, particularly paediatric urologists, and andrologists there is much debate regarding the significance of testicular artery sparing when performing a varicocelectomy, with some believing that ligating the testicular artery impairs catch-up growth and future fertility. On the other hand, several studies have reported higher failure rates with artery preservation. To help resolve the debate regarding the significance of artery sparing, we sought to compare varicocoele recurrence rate and catch-up growth in patients who underwent artery sparing laparoscopic varicocelectomy compared with those who had the artery sacrificed. We identified 524 laparoscopic varicocelectomies in 425 patients from our adolescent varicocoele database. Only patients who had ultrasound determined testicular volume measurements pre-operatively and at least 6 months post-operatively were included. Post-operative persistence/recurrence of varicocoele, testicular atrophy and repeat varicocelectomy were noted. Catch-up growth was compared between procedures in those with significant pre-operative asymmetry. Four hundred and forty primary laparoscopic varicocelectomies were performed in 355 patients (mean age: 15.5 years, range 9.3-20.6; mean follow-up: 32.9 months, range 6.0-128.9) who had both pre- and post-varicocelectomy scrotal Duplex Doppler ultrasound performed. The testicular artery was preserved in 54 varicocoeles (41 patients) and ligated in 384 varicocoeles (312 patients). We observed an increased rate of persistent/recurrent varicocoele in the artery-sparing vs. artery ligating patients (12.2% vs. 5.4%, p = 0.09). In addition, there was no difference in catch-up growth and no instance of testicular atrophy. As artery sparing varicocelectomy offered no advantage in regards to catch-up growth and was associated with a higher incidence of recurrent varicocoele, preservation of the artery does not appear to be routinely necessary in adolescent varicocelectomy.

Ultrasound measurements of testicular volume: Comparing the three common formulas with the true testicular volume determined by water displacement

ObjectiveTo determine the accuracy of various ultrasound formulas for measuring the testicular volume in humans by comparing the resultant measurements with the actual testicular volume. Subjects and methodsThe testicular volume of 121 testes from 62 patients with prostate cancer (mean age 72.7±9.4) was measured using ultrasonography before therapeutic bilateral orchidectomy. The ultrasound measurements of the testicular volume were calculated using the following three formulas: (a) length (L)×width (W)×height (H)×0.52; (b) L×W2×0.52 and (c) L×W×H×0.71. The actual testicular volume was determined by water displacement of the testis. ResultsThe mean actual testicular volume was 10.6±3.5ml. A strong correlation was found between the actual testicular volume and the volume calculated by the three-ultrasound formulas (r=0.853–0.871, p=0.0001). The smallest mean difference from the actual testicular volume was observed with the formula L×W×H×0.71, which underestimated the actual volume by 0.4ml (3.9%). ConclusionThe results of this study show that ultrasonography and the formula L×W×H×0.71 are the most accurate method for the calculation of the testicular volume.

Effects of a Commercial Canine Gonadotropin Releasing Hormone Vaccination on Intact Male Llamas and Alpacas

We have investigated the effect of immunization against gonadotropin releasing hormone (GnRH) using a commercial canine GnRH vaccine on testosterone concentration, testicular volume, testicular histology, and intermale behavior in intact male llamas and alpacas. Llamas (n=28) and alpacas (n=20) were either immunized (received 3 mL of vaccine given intramuscularly) or treated as controls (received 3 mL of sterile diluent given intramuscularly) at 0, 3, and 6 weeks. Blood samples and testicular volume measurements were taken at 0, 3, 6, 9, and 12 weeks. Owner surveys grading behavior at 0 and 12 weeks were received for 14 llamas. Two llamas at each time point undergoing the vaccination procedure were also castrated for testicular histological examination. Vaccinated animals elicited a GnRH antibody titer, and there was a significant decrease in testosterone concentration and testicular volume when compared with control animals. Intermale aggressive behavior was also significantly decreased in the surveyed llamas. However, histological examination revealed no significant changes. GnRH immunization using the canine GnRH vaccine may be an effective method for reducing intermale aggression in llamas and alpacas by decreasing circulating testosterone concentrations but cannot be recommended as an immunosterilant because of its lack of efficacy in interrupting spermatogenesis.

Cross-Sectional Analysis of Penile Length in Males 13 to 15 Years Old According to Pubertal Development Stages

Genital development is affected by pubertal process to a great extent, and puberty is a complex phenomenon that is influenced by multiple factors resulting in individual differences. We studied penile length and its relationship to pubertal stage in boys 13 to 15 years old. Healthy boys who were candidates for military high school were evaluated between June and July 2011. Age, residence and body mass index were recorded. Stretched penile length was measured. Pubic hair was assessed according to Tanner and Marshall staging. Genital puberty stage was defined by measurement of testicular volume with Prader orchidometer. Relationship of penile length to age, residence, pubertal stages and body mass index was evaluated statistically. A total of 1,539 boys were included in the study. Mean ages and number of patients according to genital stage were as follows. Mean age was 14 years for genital stage 1 (5 patients), 13.9 years (range 13 to 15) for stage 2 (194), 14.07 years (13 to 15) for stage 3 (965) and 14.11 years (13 to 15) for stage 4 (375). Linear regression analysis revealed a significant effect of body mass index, genital stage and pubic hair stage on penile length (p <0.001) but no significant effect of age or residence. Mean penile length was significantly different among different age groups and among pubertal stages. However, mean penile lengths of different age groups within the same pubertal stage were similar. Penile length during puberty should be evaluated individually according to the current pubertal stage. Our study offers a reliable reference table of penile length for pubertal age group.

Testicular volume and semen parameters in patients aged 12 to 17 years with idiopathic varicocele

PurposeVaricocele is potentially a progressive condition that may affect fertility. The authors have encouraged sperm banking for their postpubertal patients with varicocele and aim to evaluate the sperm parameters in this cohort of patients. MethodsWith institutional ethical approval, sperm variables (volume, concentration, and forward motility) of patients with postpubertal varicocele who opted for sperm banking were prospectively recorded. The following parameters were also acquired: (a) ultrasound measurement of testicular volume, (b) clinical grade, and (c) venous Doppler. Patients were divided into 2 groups: symmetrical testis (group A) and asymmetrical testis (group B). Testicular asymmetry was defined as greater than 20% difference in testicular volume compared with contralateral testis. Sperm parameters were compared between groups A and B using Mann-Whitney U test and P < .05. ResultsFifteen patients were included: 10 in group A and 5 in group B. Median semen concentration in group B was significantly lower than group A (3 vs 26 million/mL; P = .04). One hundred percent of group B failed World Health Organisation adult criteria for normal spermiograms compared with 50% of group A. ConclusionsSperm concentration and quality was lower in patients with asymmetrical testis. Testicular dysfunction may be present before the onset of testicular hypotrophy. When testicular hypotrophy is present, testicular dysfunction is very likely.

Subclinical Varicocele and Sports: A Longitudinal Study

To evaluate the influence of physical activity on the evolution of subclinical varicocele because subclinical and clinical varicoceles are common in adolescents. The study enrolled healthy male volunteers (athletes and nonathletes) and athletes with subclinical varicocele from October 2006 to March 2007. A fourth group of nonathletes with subclinical varicocele was created. Subclinical varicocele was defined as spermatic vein reflux detected with Doppler velocimetry only with the Valsalva maneuver. All patients were pubertal boys of 14-16 years old. Those practicing sports on a regular basis ≥3 times weekly for ≥2 consecutive hours were considered athletes. The boys were examined every year for 3 years from October 2006 to March 2010. At each examination, each patient underwent Doppler velocimetry and testicular volume measurements with a standard orchidometer. The rate of progression to a clinically palpable varicocele and its relationship to sport practice was also assessed. The follow-up compliance rate was 80%. The rate of progression to a clinically palpable varicocele was significantly greater in the athletes with a subclinical varicocele than in the healthy group (athletes and nonathletes) without a subclinical varicocele (36% vs 5%, respectively; P < .05). The probability of developing a subclinical varicocele for healthy athletes and healthy nonathletes was similar (23% vs 20%, respectively). Subclinical varicocele should be considered as the first stage of varicocele development. Although sports practice seemed to cause progression to a clinical varicocele, this finding was confirmed only in patients already affected by spermatic vein reflux (subclinical varicocele).

Natural history and long‐term testicular growth of acquired undescended testis after spontaneous descent or pubertal orchidopexy

To assess prospectively the natural history and long-term testicular growth of acquired undescended testis (UDT) after spontaneous descent or pubertal orchidopexy in case of nondescent. From 1996 until 2008, 391 boys with 464 acquired UDT were included in the study. In accordance with Dutch consensus on non-scrotal testes, spontaneous descent at puberty was awaited; if this did not take place, orchidopexy was performed at puberty. Acquired UDT was defined as a testis previously residing in the scrotum that can no longer be manipulated into a stable scrotal (high scrotal) or nonscrotal (inguinal, impalpable) position. After referral, testis position, testis volume and puberty stage were monitored annually until adolescence. Testis volume was assessed using an orchidometer and compared with the Dutch standard. All investigations were carried out by the same physician (W.H.). Of these boys, 84 (mean age 12.9 years, range 6.4-21.3) were also clinically assessed by a second physician (J.G.), unaware of the results of the first examination. In addition, these boys were assessed with testicular ultrasonography, carried out by both physicians. Currently the mean (range) follow-up is 4.7 (0.1-12.0) years, and 253 acquired UDT have reached the scrotum. In 196 of these 253 cases (77.5%), there was spontaneous descent at puberty (mean age at descent 12.9 years, range 9.8-16.9); in the other 57 cases (22.5%), pubertal orchidopexy was required due to nondescent; five cases required orchidectomy. Of the 494 testis volume measurements after spontaneous descent, 458 (92.7%) were at ≥10th centile for age, of which 311 (63.0%) were ≥50th centile, and 107 (21.7%) ≥90th centile. After pubertal orchidopexy for nondescent, of the 85 measurements, 79 (92.9%) were at ≥10th centile, 53 (62.4%) ≥50th centile and 12 (14.1%) ≥90th centile. In unilateral cases, after spontaneous descent 174 of the 294 (59.2%) retained testes were found to be smaller than their counterpart and 90 of 294 (30.6%) were equal in size. After pubertal orchidopexy in unilateral cases, 40 of the 51 (78.4%) testes were smaller, and nine (17.6%) were equal in size. There was a strong correlation between both investigators for the measurement of testicular volume by orchidometer, and for the main investigator (W.H.) between his measurements by ultrasonography and the Prader orchidometer. Acquired UDT has a 77.5% tendency of spontaneous descent at puberty. In nearly all cases, after spontaneous descent as well as after pubertal orchidopexy, long-term testicular growth is within the normal range.

Adolescent Varicocele: Influence of Tanner Stage at Presentation on the Presence, Development, Worsening and/or Improvement of Testicular Hypotrophy Without Surgical Intervention

Testicular asymmetry in adolescents with varicocele can worsen, remain unchanged or decrease on followup. We determined the incidence of testicular asymmetry at presentation by Tanner stage and the correlation between Tanner stage at presentation and subsequent changes in percent asymmetry (ability for catch-up growth or progressive asymmetry) without surgical intervention. We retrospectively studied the records of 115 boys with a mean age of 14.1 years (range 9.2 to 20.0) with grade 2 or 3 left varicocele who underwent testicular volume measurement at 2 visits at least that were a minimum of 6 months apart. Of the patients 92% and 8% underwent Doppler duplex ultrasound and orchidometry, respectively. Patients were divided into 2 groups, including those with less than 15% and those with 15% or greater asymmetry. Catch-up growth was defined as less than 15% asymmetry at any subsequent visit. At presentation 58%, 64%, 67%, 35% and 39% of Tanner 1 to 5 cases showed 15% or greater testicular asymmetry, respectively. When Tanner 1 to 3 cases were combined and compared with Tanner 4 and 5 cases, the difference in initial asymmetry was significant (64% vs 38%, p = 0.007). Although it was not statistically significant, there was a trend toward more catch-up growth for the later Tanner stages, including 27% for Tanner 1 to 3 vs 53% for Tanner 4 and 5 (p = 0.06). Slightly more than 50% of children and adolescents referred with varicocele have 15% or greater testicular asymmetry at presentation. Initial asymmetry is statistically more common in cases of earlier Tanner stages (1 to 3). Adolescents with 15% or greater testicular asymmetry who present at higher Tanner stages (4 and 5) show a trend toward a higher incidence of catch-up growth, although it is not significant.

Differential Diagnosis of Azoospermia and Etiologic Classification of Obstructive Azoospermia: Role of Scrotal and Transrectal US

To evaluate the usefulness of scrotal and transrectal ultrasonography (US) in the differential diagnosis of azoospermia and the etiologic classification of obstructive azoospermia. This study was approved by the institutional ethics committee, and all patients provided written informed consent. Between April 2006 and November 2008, 100 infertile men (mean age, 32 years; range, 22-51 years) with azoospermia were evaluated at scrotal and transrectal US, with an emphasis on abnormal US findings of the seminal tract and measurement of testicular volume. On the basis of the results of percutaneous epididymal sperm aspiration, testicular fine-needle aspiration cytology, or testicular biopsy, 97 patients with azoospermia were divided into obstructive or nonobstructive groups. The remaining three patients had Klinefelter syndrome and did not undergo testicular biopsy. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of different indexes for discrimination between obstructive and nonobstructive azoospermia. Cases of obstructive azoospermia were further classified according to obstructive causes. Seminal tract abnormalities were more common in obstructive (92.2% [59 of 64 patients]) than in nonobstructive (2.8% [one of 36 patients]; P < .001) azoospermia. Testicular volume was significantly larger for obstructive (median, 16.0 mL; range, 8.4-27.5 mL) than for nonobstructive (median, 8.6 mL; range, 0.9-21.0 mL; P < .001) azoospermia. The area under the ROC curve for discrimination between the groups through combined assessment of the seminal tract and testicular volume at scrotal and transrectal US was 0.96. Sensitivity, specificity, and accuracy for combined assessment in discriminating between obstructive and nonobstructive azoospermia were 95.3% (61 of 64 patients), 97.2% (35 of 36), and 96.0% (96 of 100), respectively. Scrotal US and transrectal US are effective imaging modalities for distinguishing obstructive from nonobstructive azoospermia and can provide meaningful diagnostic information for determining the etiologic classification of obstructive azoospermia.

Testicular Asymmetry and Adolescent Varicoceles Managed Expectantly

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. 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. 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). 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.

Measurement of Testicular Volume in Smaller Testes: How Accurate Is the Conventional Orchidometer?

The aim of this study was to evaluate the accuracy of different methods, including the Seager orchidometer (SO) and ultrasonography (US), for assessing testicular volume of smaller testes (testes volume less than 18 mL). Moreover, the equations used for the calculations--the Hansen formula (length [L] x width [W](2) x 0.52, equation A), the prolate ellipsoid formula (L x W x height [H] x 0.52, equation B), and the Lambert equation (L x W x H x 0.71, equation C)--were also examined and compared with the gold standard testicular volume obtained by water displacement (Archimedes principle). In this study, 30 testes from 15 men, mean age 75.3 (+/-8.3) years, were included. They all had advanced prostate cancer and were admitted for orchiectomy. Before the procedure, all the testes were assessed using SO and US. The dimensions were then input into each equation to obtain the volume estimates. The testicular volume by water displacement was 8.1 +/- 3.5 mL. Correlation coefficients (R(2)) of the 2 different methods (SO, US) to the gold standard were 0.70 and 0.85, respectively. The calculated testicular volumes were 9.2 +/- 3.9 mL (measured by SO, equation A), 11.9 +/- 5.2 mL (measured by SO, equation C), 7.3 +/- 4.2 mL (measured by US, equation A), 6.5 +/- 3.3 mL (measured by US, equation B) and 8.9 +/- 4.5 mL (measured by US, equation C). Only the mean size measured by US and volume calculated with the Hansen equation (equation A) and the mean size measured by US and volume calculated with the Lambert equation (equation C) showed no significant differences when compared with the volumes estimated by water displacement (mean difference 0.81 mL, P = .053, and 0.81 mL, P = .056, respectively). Based on our measurements, we categorized testicular volume by different cutoff values (7.0 mL, 7.5 mL, 8.0 mL, and 8.5 mL) to calculate a new constant for use in the Hansen equation. The new constant was 0.59. We then reexamined the equations using the new 0.59 constant, and found that the equation Volume (V) = L x W(2) x 0.59 was the best for describing testicular volume among our subjects (difference between the new equation and the gold standard of water displacement = 0.19 mL, P = .726). We also found that US was more precise in measuring testicular dimensions. We propose a new formula, V = L x W(2) x 0.59, to assess the volumes of smaller testes.

A simple orchidometric method for the preliminary assessment of maturity status in male cynomolgus monkeys ( Macaca fascicularis) used for nonclinical safety studies

Introduction The identification and use of mature male non-human primates in nonclinical toxicology studies could be important for evaluating candidate drugs for which the profile of toxicity may differ depending on sexual maturity. This investigation sought to establish operational criteria to complement the current standard of histological evaluation for defining sexual maturity in male cynomolgus monkeys (Macaca fascicularis) used for toxicology studies, and to identify a practical non-invasive measure to select mature males for study. Method Retrospectively, the relationships between body weight, testicular weight and testis histology were established in control males ( n = 126) used in previous toxicology studies. Prospectively, testicular volumes were measured in-life by orchidometry using comparative scrotal palpation ( n = 23 males used for study), then compared to testicular weights measured at necropsy. Results Consistent with previous literature, a weak relationship was observed between body weight and testicular weight. There was, however, a very good relationship between testicular weight and histological maturation level, which was based upon microscopic examination of testes, epididymides and prostates. Orchidometric measurement of testicular volume was found to be a reasonable predictor of testicular weight and served to rapidly select sexually mature males for study, and a total testicular volume (left and right combined) of > 20 ml correlated with the histological appearance of maturity. Conclusion Based upon this preliminary exploratory study, the initial simple measurement of testicular volume by orchidometry may provide a non-invasive alternative approach for assessing the sexual maturity of male cynomolgus monkeys in research colonies or during toxicology studies that will require more thorough validation.

Gonadal Dysfunction in Male Childhood Cancer Survivors

Hematology-Oncology| May 01 2009 Gonadal Dysfunction in Male Childhood Cancer Survivors AAP Grand Rounds (2009) 21 (5): 58. https://doi.org/10.1542/gr.21-5-58 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Gonadal Dysfunction in Male Childhood Cancer Survivors. AAP Grand Rounds May 2009; 21 (5): 58. https://doi.org/10.1542/gr.21-5-58 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: childhood cancer, gonadal dysfunction, survivors Source: van Casteren N, van der Linden G, Hakvoort-Cammel FGAJ, et al. Effect of childhood cancer treatment on fertility markers in adult male long-term survivors. Pediatr Blood Cancer. 2009;52(1):108–112; doi:10.1002/pbc.21780 To assess the impact on gonadal function of the treatment of childhood cancer in males, investigators from the Netherlands evaluated fertility markers in long-term survivors between 2003 and 2006. The survivors were at least 18 years of age and at least five years out from the completion of their therapy. Evaluations consisted of testicular volume measurements and levels of serum lutenizing hormone (LH), follicle stimulating hormone (FSH), testosterone, and Inhibin B, a serum marker of spermatogenesis. Sperm analysis was performed in all the controls and in a subset of the survivors. A total of 248 cancer survivors and 74 normospermic male controls recruited from a fertility clinic participated. Among cancer survivors, the median age at diagnosis was five years (range 0–15 years), median age at follow-up was 23 years (range 18–41 years), and median follow-up interval was 18 years (range 5–39 years). FSH and LH levels were significantly higher in the survivor group (median values 4.6 U/L and 3.6 U/L, respectively) than in controls (3.6 U/L and 2.7 U/L, respectively). Testosterone levels and testicular volumes were not statistically different in the two groups. Inhibin B proved to be the most sensitive discriminator between survivors and controls. Significantly more cancer survivors had Inhibin B levels below 150 ng/L (previously shown to be a cut-off value for identifying males with low semen quality1) than control males (67% vs 26%). Median Inhibin B levels were lowest among survivors of Hodgkin (54 ng/L) and non-Hodgkin (88 ng/L) lymphomas, acute myeloid leukemias (68 ng/L), sarcomas (55 ng/L), and neuroblastomas (79 ng/L) and highest among survivors of acute lymphoblastic leukemias (140 ng/L) and renal tumors (146 ng/L). Treatment regimens containing procarbazine or cyclophosphamide were independent predictors for low Inhibin B levels (P<.01). Age at the time of treatment did not influence Inhibin B levels or FSH levels. In both normals and a subgroup of 21 survivors, Inhibin B levels correlated with sperm concentration. The investigators conclude that severe gonadal impairment is a risk in a considerable subgroup of male childhood cancer survivors regardless of whether the treatment occurred before or after the onset of puberty. Dr. Villella has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Improved survival for childhood cancer is a major medical success story: in the near future, one out of every 450 individuals will be a long-term survivor of childhood cancer.2 Long-term side effects from chemotherapy and/or radiation, however, are significant (see AAP Grand Rounds, December 2008;20:63–643; December 2007;18:62–634; February 2005;13:13–145). The findings of this study demonstrate an alarming rate of gonadal dysfunction in male survivors of childhood cancer. Previous studies have demonstrated similar results6,–9... You do not currently have access to this content.