Department of Urology, Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
J Urol. 2010 Feb;183(2):731-4. doi: 10.1016/j.juro.2009.10.028.
Adolescent varicocele is often associated with testicular asymmetry. Depending on the degree of asymmetry, some physicians will recommend surgery. However, given the possibility that asynchronous growth may be transient, others advocate for a period of observation. We reviewed our outcomes in such patients who were initially treated expectantly.
We retrospectively reviewed our pediatric varicocele database. We analyzed the outcomes of patients presenting for evaluation of varicocele who were followed with serial testicular volume measurements using scrotal ultrasound or ring orchidometry and who had at least a 6-month interval between measurements. Fisher's exact test was used to compare groups based on initial and final testicular asymmetry.
We identified 181 patients (median age 13.8 years) who were followed expectantly. Serial volume measurements had been obtained at a median interval of 12 months (interquartile range 8 to 21) between first and most recent visits. Mean percent asymmetry for the group did not change with time. Among patients who initially had less than 20% asymmetry 35% had 20% or greater asymmetry on followup, and among those with 20% or greater asymmetry initially 53% remained in that range (p = 0.007).
Asymmetry can be a transient phenomenon. Patients with initial asymmetry can end up with significant asymmetry, and many with significant asymmetry can have catch-up growth. However, when patients have a peak retrograde flow of 38 cm per second or greater on duplex Doppler ultrasound in association with 20% or greater asymmetry spontaneous catch-up growth is unlikely to occur.
青少年精索静脉曲张常伴有睾丸不对称。根据不对称的程度，一些医生会建议手术。然而，鉴于异步生长可能是暂时的，其他人主张观察一段时间。我们回顾了最初接受期待治疗的此类患者的结果。
我们回顾性地审查了我们的小儿精索静脉曲张数据库。我们分析了接受精索静脉曲张评估并使用阴囊超声或环睾测量法进行连续睾丸体积测量的患者的结果，并且两次测量之间至少有 6 个月的间隔。Fisher 精确检验用于根据初始和最终睾丸不对称比较组。
我们确定了 181 名（中位年龄 13.8 岁）接受期待治疗的患者。中位数为 12 个月（四分位间距为 8 至 21）的中位数间隔获得了系列体积测量值，即第一次和最近一次就诊之间。组的平均百分比不对称性随时间没有变化。在最初不对称性小于 20%的患者中，35%的患者在随访时有 20%或更大的不对称性，而最初有 20%或更大的不对称性的患者中有 53%仍处于该范围内（p = 0.007）。
不对称性可能是一种短暂的现象。最初有不对称性的患者最终可能会出现明显的不对称性，而许多有明显不对称性的患者可能会出现追赶性生长。然而，当患者在双功能多普勒超声上有 38 厘米/秒或更大的峰值逆行流量并伴有 20%或更大的不对称性时，自发追赶性生长不太可能发生。
