Preston Mark A, Carnat Toby, Flood Trevor, Gaboury Isabelle, Leonard Michael P
Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
Urology. 2008 Jul;72(1):77-80. doi: 10.1016/j.urology.2008.02.005. Epub 2008 Apr 18.
To determine whether adolescents with varicoceles experience physiologic testicular "catch-up" growth during development, thereby providing a role for conservative management of adolescent varicoceles.
An internal review board-approved retrospective chart review of the Children's Hospital of Eastern Ontario patient database was conducted. Patients presenting with a varicocele between January 1999 and January 2005 were selected. Varicocele grade, ultrasound-determined testicular volume differential over time, and need for surgery were recorded. The difference between left and right testicular volume at diagnosis and at study completion was compared and statistically analyzed.
A total of 33 boys with a median age of 13.4 years (range, 8.8 to 16.1 years) was selected. Patients presented with clinical varicocele grades 3 (63.6%), 2 (33.3%), and 1 (3.0%). Of 33 patients, 3 (9.1%) required surgery for pain (1) and increasing testicular size discrepancy (2). A significant decrease was observed in the percentage difference between left and right testicular volumes over time (P = 0.017). This remained significant even after adjustment for age, length of observation, and need for surgery (P = 0.026). Of 14 patients with an initially significant difference in testicular volume (greater than 20%) who were managed conservatively, 7 experienced testicular catch-up growth (volume differential less than 20%) (P = 0.016).
Some adolescent boys with a varicocele and considerable testicular size discrepancy manifest significant testicular "catch-up" growth during continued physiologic development. However, those patients who show a testicular size discrepancy that is steadily increasing should be considered for surgical intervention.
确定患有精索静脉曲张的青少年在发育过程中是否经历生理性睾丸“追赶”生长，从而为青少年精索静脉曲张的保守治疗提供依据。
对安大略东部儿童医院患者数据库进行了一项经内部审查委员会批准的回顾性图表审查。选取1999年1月至2005年1月期间出现精索静脉曲张的患者。记录精索静脉曲张分级、超声测定的睾丸体积随时间的差异以及手术需求。比较并统计分析诊断时和研究结束时左右睾丸体积的差异。
共选取了33名男孩，中位年龄为13.4岁（范围8.8至16.1岁）。患者临床精索静脉曲张分级为3级（63.6%）、2级（33.3%）和1级（3.0%）。33例患者中，3例（9.1%）因疼痛（1例）和睾丸大小差异增大（2例）需要手术。随着时间的推移，左右睾丸体积的百分比差异显著降低（P = 0.017）。即使在调整年龄、观察时间和手术需求后，这一差异仍具有统计学意义（P = 0.026）。14例最初睾丸体积差异显著（大于20%）且接受保守治疗的患者中，7例经历了睾丸追赶生长（体积差异小于20%）（P = 0.016）。
一些患有精索静脉曲张且睾丸大小差异较大的青少年男孩在持续的生理发育过程中表现出显著的睾丸“追赶”生长。然而，那些睾丸大小差异持续增加的患者应考虑手术干预。
