Testis size may not be accurate determinant of long-term varicocele pathology
MedWire News: The traditional method of comparing left with right testis size in boys with left varicocele to determine whether surgery is necessary may not capture their long-term pathology, report researchers.
Their study results show that the left testis is smaller than the right in boys with left varicocele no matter what their age, but that between the ages of 10-15 years, both the left and right testes of boys with varicocele are larger when compared with the testes of healthy boys.
A further complication shows that from the age of 16 years, when puberty is resolved, both testes of boys with left varicocele are smaller than the testes of healthy boys, say John Chen (Stony Brook University Medical Centre, New York, USA) and colleagues.
"The global effect of varicocele, a unilateral testicular problem, on fertility has always been curious and yet undeniably true for at least some patients," write Chen and team in the journal Urology.
"Because we find that both the right and left testes are diminished in size in older boys with varicocele, the occurrence of infertility may be less mysterious," they add.
Based on their knowledge and observation, pediatric urologists have historically recommended varicocele ligation for adolescents with varicocele and ipsilateral testicular hypotrophy if the left testis is smaller than the right, explain Chen et al. However, recent findings have shown that boys in these circumstances often demonstrate "catch-up" growth of the affected testicle without surgical intervention.
For the current study, the researchers compared testes size in a cohort of 265 boys aged 10 to 18 years. They received a sonogram for symptoms including testicular pain and scrotal swelling or pain, and 81 were diagnosed with left varicocele. The remaining 184 boys formed the healthy group. Participants aged 16 years and over were considered to be at the same stage of puberty, ie, that they had transited stage 5 hair and genital development.
Analysis showed that the right testes of boys with left varicocele were significantly larger in length and volume than the left no matter what age they were. No significant differences in testes size were noted among healthy boys.
After adjustment for age, boys with varicocele aged between 10 and 15 years had left testes that were slightly larger than those of the healthy boys, but not statistically significantly so, whereas their right testes were significantly larger than those of the healthy boys.
In boys with varicocele aged 16 years or more, the trend was for left testes to be smaller than those of healthy boys, while right testes were significantly smaller than the right testes of healthy boys.
This pattern remained the same when the left and right combined testicular sizes were compared, note Chen and co-investigators.
"Our findings suggest that comparing right with left testicular size may not be as important as comparing contralateral right with right of boys without varicocele," says the team, adding that the study "provides caution that for varicocele patients managed with observation, the catch-up growth of the left testis may only represent diminution in the size of the right testis."
The group concludes: "This calls for well developed testicular size nomograms that will allow clinicians to make proper management decisions based on comparisons of testicular size in varicocele patients with normal standards."
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By Sarah Guy