Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York-Presbyterian, Department of Urology, Columbia University College of Physicians and Surgeons New York, New York 10032, USA.
J Urol. 2010 Oct;184(4 Suppl):1727-32. doi: 10.1016/j.juro.2010.05.053. Epub 2010 Aug 21.
Testicular asymmetry in adolescents with varicocele can worsen, remain unchanged or decrease on followup. We determined the incidence of testicular asymmetry at presentation by Tanner stage and the correlation between Tanner stage at presentation and subsequent changes in percent asymmetry (ability for catch-up growth or progressive asymmetry) without surgical intervention.
We retrospectively studied the records of 115 boys with a mean age of 14.1 years (range 9.2 to 20.0) with grade 2 or 3 left varicocele who underwent testicular volume measurement at 2 visits at least that were a minimum of 6 months apart. Of the patients 92% and 8% underwent Doppler duplex ultrasound and orchidometry, respectively. Patients were divided into 2 groups, including those with less than 15% and those with 15% or greater asymmetry. Catch-up growth was defined as less than 15% asymmetry at any subsequent visit.
At presentation 58%, 64%, 67%, 35% and 39% of Tanner 1 to 5 cases showed 15% or greater testicular asymmetry, respectively. When Tanner 1 to 3 cases were combined and compared with Tanner 4 and 5 cases, the difference in initial asymmetry was significant (64% vs 38%, p = 0.007). Although it was not statistically significant, there was a trend toward more catch-up growth for the later Tanner stages, including 27% for Tanner 1 to 3 vs 53% for Tanner 4 and 5 (p = 0.06).
Slightly more than 50% of children and adolescents referred with varicocele have 15% or greater testicular asymmetry at presentation. Initial asymmetry is statistically more common in cases of earlier Tanner stages (1 to 3). Adolescents with 15% or greater testicular asymmetry who present at higher Tanner stages (4 and 5) show a trend toward a higher incidence of catch-up growth, although it is not significant.
精索静脉曲张青少年的睾丸不对称性可能会在随访中恶化、保持不变或减轻。我们通过睾丸发育分期来确定就诊时睾丸不对称的发生率，并通过非手术干预来确定就诊时的睾丸发育分期与随后的百分比不对称变化（追赶生长或进行性不对称的能力）之间的相关性。
我们回顾性研究了 115 名平均年龄为 14.1 岁（范围 9.2 至 20.0）的男孩的记录，这些男孩均患有 2 级或 3 级左侧精索静脉曲张，并且在至少两次就诊时进行了睾丸体积测量，两次就诊时间至少间隔 6 个月。92%的患者和 8%的患者分别接受了多普勒双功能超声和睾丸容积测量。患者分为两组，一组为睾丸体积不对称小于 15%，另一组为睾丸体积不对称大于或等于 15%。追赶生长定义为在任何后续就诊时睾丸体积不对称小于 15%。
就诊时，睾丸发育分期 1 至 5 期的病例中，分别有 58%、64%、67%、35%和 39%的病例出现睾丸体积不对称大于 15%。将睾丸发育分期 1 至 3 期的病例合并与睾丸发育分期 4 和 5 期的病例比较，初始不对称的差异具有统计学意义（64%对 38%，p=0.007）。尽管没有统计学意义，但后期睾丸发育分期的追赶生长趋势更为明显，包括睾丸发育分期 1 至 3 期的 27%对睾丸发育分期 4 和 5 期的 53%（p=0.06）。
就诊时，略多于 50%的精索静脉曲张患儿存在睾丸体积不对称大于 15%。在睾丸发育分期较早的病例中（1 至 3 期），初始不对称更为常见。就诊时睾丸发育分期较高（4 和 5 期）且睾丸体积不对称大于 15%的青少年，追赶生长的发生率呈上升趋势，但无统计学意义。
