BUENOS AIRES, ARGENTINA (UroToday.com) - Kenneth I. Glassberg, MD - Professor of Urology and Director, Division of Pediatric Urology, Morgan Stanley Children’s Hospital, New York Presbyterian Medical Center, Discussed the importance of varicoceles in adolescents against the published data indicating the high incidence of varicoceles in subfertile men (41%), the documented improvement in semen parameters after varicocelectomy (60-70%) and fertility rates (40%).

He highlighted the reported incidence of varicocelectomy in adolescents (14.7-16.2%). Since ipsilateral testicular hypotrophy is noted in men with unilateral varicoceles worse semen parameter, Dr Glassberg supported the practice of utilizing testicular asymmetry as an indication for adolescent varicocelectomy. He presented an atrophy index = Right testicular volume (cc’s) – left volume (cc’s)/Right testicular volume x 100. Atrophy was defined as less than 10% atrophy.

He presented data from Diamond et al (2007) indicating >10% testicular asymmetry in Tanner V boys correlates with significantly decreased sperm concentration. When the asymmetry index was greater than 20%, the decrease in sperm concentrations was even greater. The work by Paduch and Niedzielski, 1996 indicating the venous backflow velocity correlated with the degree of testicular atrophy and worse semen parameters was then utilized as the foundation for a similar analysis by Dr Glassberg. In his study he attempted to determine a relationship exists between PRF (peak reflux flow) and testicular asymmetry in adolescents and to see if the PRF could be used to predict: 1.persistent 2. progressive or 3. In this prospective study there were 77 patients with a mean age if 14.3 yrs (Range 9-20). Progressive asymmetry was noted in 42/77 (55%), new onset asymmetry: 18/27 (66%) and deceasing asymmetry in 9/77 (12%) The testicular asymmetry index was correlated with PRF. All boys with initial asymmetry index of over 20% and PRF over 38 continued to have asymmetry. This was taken as an indication for early intervention. PRF of over 38 was also found in those with new onset of asymmetry. Those with lower PRF (less than 30) were more likely to have lessening of asymmetry. Thus this parameter would indicate continued observation. If the PRF was ≥ 38 cm/sec the adolescents were more likely to have ≥ 20% asymmetry on follow-up and were thus more likely to require varicocelectomy.

Dr Glassberg then presented data on paternity data obtained from 50 Orthodox Jewish men over 21 years of age who had undergone varicocelectomy during adolescence. The average age at surgery was 15 yrs. The average age at the time of questionnaire was 24 yrs. Of the 14 married, all had achieved pregnancy.

He concluded that varicocelectomy in adolescents does no harm and may preserve fertility.

Presented at the 2007 Annual Meeting of the New York Section of the AUA in Buenos Aires, Argentina - November 11-16, 2007

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Written by Harris M. Nagler, MD, a Contributing Editor with UroToday.

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