|Year : 2005 | Volume
| Issue : 2 | Page : 126-127
Does testicular hypotrophy correlate with grade of adolescent varicocele?
J Chandra Singh, Nitin S Kekre
Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India
J Chandra Singh
Department of Urology, Christian Medical College,Vellore – 632 004, Tamilnadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Chandra Singh J, Kekre NS. Does testicular hypotrophy correlate with grade of adolescent varicocele?. Indian J Urol 2005;21:126-7
Testicular hypotrophy does not correlate with grade of adolescent varicocele.J Urol. 2005;174:2367-70.Alukal JP, Zurakowski D, Atala A,Bauer SB, Borer JG, Cilento BG Jr et al.
| Comments|| |
This is a retrospective study from the Children's Hospital, Boston. 168 boys with unilateral varicocele and a normal contralateral testis were included. One of the eight consultant urologists had graded the varicocele. Mean age was 14.9 years (8-21).Testicular volume was determined using scrotal ultrasonogram. Testicular disproportion was determined using the formula [(size of unaffected testis) - (size of affected testis)]/(size of unaffected testis) × 100%. Testicular volume differential was categorized as less than 10%, 10% to 20% or greater than 20%. This categorization was based on an earlier cross sectional survey by Zachmann et al which concluded that 10% size variance between testes without associated abnormalities is normal. The sample size was calculated to detect a difference of 10% in differential volume among the 3 grades. With a sample size of 25, the study would have 90% power to detect a difference of 10% in differential volume among the 3 grades. Out of 168 boys, 26 (15%) had grade I, 61 (36%) had grade II and 81 (48%) had grade III varicocele. Testicular volume differential was compared between varicocele grades by analysis of variance (ANOVA). It was observed that there was no significant difference in mean volume differential between the 3 varicocele grades. Categorizing them according to the volume differential did not reveal any significant correlation between the varicocele groups. Hence the authors have concluded that the findings suggest that varicocele grade and volume differential in adolescents are independent variables.
In this study, the authors have used ultrasonographic measurement of volume which is more accurate than Vernier caliper measurement of dimensions or assessment using an orchidometer. Minimizing inter-observer variability and having one investigator grade all the varicoceles will yield more reliable stratification among the different grades but these are possible only in prospective studies. In a similar retrospective study of 114 boys with a mean age of 13 years though the proportion of boys with testicular hypotrophy was not significantly more with higher grade varicocele, it was observed that 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.
In this study, grade I,II and III varicoceles were seen in in 15%,36% and 48% respectively. Nussinovitch et al conducted a community survey among 21,529 healthy males and the prevalence of varicocele was 6.86%. Grade I II and III were seen in 74%, 20.5% and 5.3% respectively. As mentioned by the authors in the discussion, the 'referral bias' can significantly affect the conclusions. This study was conducted in a referral centre and a good number of boys with varicocele without hypotrophy of the testis would not have been referred to a tertiary centre and this number can have a significant influence on the final results. This bias can only be avoided if the study population is randomly selected from the pool of boys with varicocele in the community. A large scale cross sectional community based survey with objective measurement of the testicular volume and varicocele grade will throw light into the association of testicular hypotrophy and grade of varicocele.
| References|| |
|1.||Alukal JP, Zurakowski D, Atala A, Bauer SB, Borer JG, Cilento BG Jr et al.Testicular hypotrophy does not correlate with grade of adolescent varicocele. J Urol 2005;174:2367-70. |
|2.||Zachmann M, Prader A, Kind HP, Hafliger H, Budliger H.Testicular volume during adolescence. Cross-sectional and longitudinal studies. Helv Paediatr Acta 1974;29:61-72. [PUBMED] |
|3.||Thomas JC, Elder JS.Testicular growth arrest and adolescent varicocele: does varicocele size make a difference? J Urol 2002;168:1689-91. [PUBMED] [FULLTEXT]|
|4.||Ku JH, Son H, Kwak C, Lee SE, Lee NK, Park YH.Impact of varicocele on testicular volume in young men: significance of compensatory hypertrophy of contralateral testis.J Urol. 2002;168:1541-4. [PUBMED] [FULLTEXT]|
|5.||Nussinovitch M, Greenbaum E, Amir J, Volovitz B.Prevalence of adolescent varicocele.Arch Pediatr Adolesc Med. 2001;155:855-6. [PUBMED] [FULLTEXT]|