Alukal Joseph P, Zurakowski David, Atala Anthony, Bauer Stuart B, Borer Joseph G, Cilento Bartley G, Mandell James, Peters Craig A, Paltiel Harriet J, Retik Alan B, Diamond David A
Department of Urology, Children's Hospital Boston, Hunnewell-3, 300 Longwood Avenue, Boston, MA 02115, USA.
J Urol. 2005 Dec;174(6):2367-70, discussion 2370. doi: 10.1097/01.ju.0000180418.23208.1d.
Testicular hypotrophy is the most widely accepted indication for correcting adolescent varicocele. Previous studies in adolescents have shown a relationship between increasing grade of varicocele and the likelihood of testicular hypotrophy. As this relationship has significant clinical implications, we studied the correlation between grade and testicular volume disproportion in our adolescent varicocele population.
We reviewed the adolescent varicocele database at our institution. A total of 168 patients 8 to 21 years old were studied. We routinely calculated testis volumes using scrotal ultrasound. Testicular disproportion was calculated using the equation [(size of unaffected testis) - (size of affected testis)]/(size of unaffected testis) x 100%. Disproportion was categorized as less than 10%, 10% to 20% and more than 20%. Varicoceles were graded by an attending urologist with the patient standing, using the system of Dubin and Amelar. Analysis of variance and Pearson chi-square indicated no significant differences in volume differential between varicocele grades.
Mean +/- SD volume differential was 18% +/- 15% for grade I, 25% +/- 20% for grade II and 19% +/- 14% for grade III. ANOVA revealed no significant difference in mean volume differential between the 3 varicocele grades (p = 0.10). When categorizing patients into 3 levels of volume differential (less than 10%, 10% to 20%, more than 20%) no significant correlation was observed between varicocele and volume differential (p = 0.48, chi-square test).
Grade of varicocele does not correlate with presence or severity of testicular disproportion in adolescent boys with varicocele as measured by scrotal ultrasound.
睾丸萎缩是矫正青少年精索静脉曲张最广泛认可的指征。既往针对青少年的研究显示，精索静脉曲张程度加重与睾丸萎缩的可能性之间存在关联。由于这种关联具有重要的临床意义，我们研究了青少年精索静脉曲张患者中精索静脉曲张程度与睾丸体积差异之间的相关性。
我们回顾了本机构的青少年精索静脉曲张数据库。共研究了168例年龄在8至21岁的患者。我们常规使用阴囊超声计算睾丸体积。睾丸差异通过公式[(健侧睾丸大小)-(患侧睾丸大小)]/(健侧睾丸大小)×100%计算得出。差异分为小于10%、10%至20%和大于20%。精索静脉曲张由一位主治泌尿外科医生在患者站立时使用杜宾和阿梅拉尔系统进行分级。方差分析和Pearson卡方检验表明，精索静脉曲张各等级之间在体积差异上无显著差异。
I级精索静脉曲张的平均±标准差体积差异为18%±15%，II级为25%±20%，III级为19%±14%。方差分析显示，3个精索静脉曲张等级之间的平均体积差异无显著差异(p = 0.10)。当将患者分为3个体积差异水平(小于10%、10%至20%、大于20%)时，未观察到精索静脉曲张与体积差异之间存在显著相关性(p = 0.48，卡方检验)。
对于患有精索静脉曲张的青少年男性，通过阴囊超声测量，精索静脉曲张程度与睾丸差异的存在或严重程度无关。
