Adolescent Varicocele—Is the 20/38 Harbinger a Durable Predictor of Testicular Asymmetry?

• Published in: The Journal of urology Vol. 189; no. 5; pp. 1897 - 1902
• Main Authors: Van Batavia, Jason P, Badalato, Gina, Fast, Angela, Glassberg, Kenneth I
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.05.2013; Elsevier
• Subjects: Adolescent; Biological and medical sciences; Child; Gynecology. Andrology. Obstetrics; Humans; Male; Male genital diseases; Medical sciences; Nephrology. Urinary tract diseases; Non tumoral diseases; Prognosis; Regional Blood Flow; Retrospective Studies; semen; testis; Testis - abnormalities; Testis - blood supply; Testis - growth & development; Urology; Varicocele; Young Adult; semen; DDUS; peak retrograde flow; CUG; PRF; adolescent; duplex Doppler ultrasound; testis; catch-up growth; varicocele; Human; Varicocele; Nephrology; Prognosis; Semen; Testicle; Male genital system; Urology; Asymmetry; Adolescent; Predictive factor; Male genital diseases; Testicular diseases
• ISSN: 0022-5347; 1527-3792
• DOI: 10.1016/j.juro.2012.11.011

Purpose Part of the management of adolescent varicocele is trying to prognosticate who with testicular asymmetry will have catch-up growth with observation and who will have persistent asymmetry. We previously reported that catch-up growth is rare when peak retrograde flow greater than 38 cm per second is associated with 20% or greater asymmetry (ie the 20/38 harbinger). We sought to determine if this 20/38 cutoff held true with a larger series, and what peak retrograde flow value should be used when 15% instead of 20% asymmetry is chosen as the cutoff. Materials and Methods We analyzed patients from our large varicocele registry who had undergone at least 2 duplex Doppler ultrasounds and had been observed for at least 10 months in the interim. Outcomes were determined regarding those who met the 20/38 cutoff and what peak retrograde flow value could be used to recommend surgery when 15% to 19.9% asymmetry was included in the cutoff value. Results Of 355 adolescent boys with left varicocele 44 (mean age 14.0 years, range 9 to 20) were followed with observation initially and met the 20/38 cutoff, while 9 additional patients met the 15/38 cutoff (initial asymmetry 15% to 19.9%). When combining both groups, only 3 boys had catch-up growth to less than 15% on followup. Thus, 50 of 53 patients did not demonstrate catch-up growth after a mean followup of 15.5 months (range 10 to 44). Conclusions Not only does a peak retrograde flow of greater than 38 cm per second hold up for predicting persistent/worsening asymmetry when combined with a 20% asymmetry cutoff, it also is an excellent predictor of persistent and/or worsening asymmetry when combined with a 15% asymmetry cutoff. Therefore, it might be unnecessary to follow an adolescent boy with observation who is at or above this 15/38 cutoff.