Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York-Presbyterian, New York, New York 10032, USA.
J Urol. 2013 May;189(5):1897-901. doi: 10.1016/j.juro.2012.11.011. Epub 2012 Nov 12.
Part of the management of adolescent varicocele is trying to prognosticate who with testicular asymmetry will have catch-up growth with observation and who will have persistent asymmetry. We previously reported that catch-up growth is rare when peak retrograde flow greater than 38 cm per second is associated with 20% or greater asymmetry (ie the 20/38 harbinger). We sought to determine if this 20/38 cutoff held true with a larger series, and what peak retrograde flow value should be used when 15% instead of 20% asymmetry is chosen as the cutoff.
We analyzed patients from our large varicocele registry who had undergone at least 2 duplex Doppler ultrasounds and had been observed for at least 10 months in the interim. Outcomes were determined regarding those who met the 20/38 cutoff and what peak retrograde flow value could be used to recommend surgery when 15% to 19.9% asymmetry was included in the cutoff value.
Of 355 adolescent boys with left varicocele 44 (mean age 14.0 years, range 9 to 20) were followed with observation initially and met the 20/38 cutoff, while 9 additional patients met the 15/38 cutoff (initial asymmetry 15% to 19.9%). When combining both groups, only 3 boys had catch-up growth to less than 15% on followup. Thus, 50 of 53 patients did not demonstrate catch-up growth after a mean followup of 15.5 months (range 10 to 44).
Not only does a peak retrograde flow of greater than 38 cm per second hold up for predicting persistent/worsening asymmetry when combined with a 20% asymmetry cutoff, it also is an excellent predictor of persistent and/or worsening asymmetry when combined with a 15% asymmetry cutoff. Therefore, it might be unnecessary to follow an adolescent boy with observation who is at or above this 15/38 cutoff.
青少年精索静脉曲张的治疗方法之一是预测睾丸不对称患者中哪些患者会出现追赶性生长，哪些患者会出现持续性不对称。我们之前的研究表明，当峰值逆行血流大于 38cm/s 且伴有 20%或更高的不对称性（即 20/38 标志）时，追赶性生长很少发生。我们试图确定当选择 15%而不是 20%的不对称性作为截止值时，这个 20/38 的截止值是否仍然适用，以及应该使用什么峰值逆行血流值。
我们分析了来自我们大型精索静脉曲张登记处的患者，这些患者至少接受了两次双功能多普勒超声检查，并在中间至少观察了 10 个月。确定了那些符合 20/38 截止值的患者的结果，以及当包括 15%至 19.9%的不对称性作为截止值时，应该使用什么峰值逆行血流值来推荐手术。
355 名患有左侧精索静脉曲张的青少年男孩中，有 44 名（平均年龄 14.0 岁，范围 9 至 20 岁）最初接受了观察，并符合 20/38 截止值，而另外 9 名患者符合 15/38 截止值（初始不对称性为 15%至 19.9%）。当将两组结合起来时，只有 3 名男孩在随访中睾丸体积减少到 15%以下。因此，53 名患者中有 50 名在平均随访 15.5 个月（范围 10 至 44 个月）后没有出现追赶性生长。
当与 20%的不对称性截止值结合时，大于 38cm/s 的峰值逆行血流不仅可以预测持续性/加重性不对称性，而且当与 15%的不对称性截止值结合时，也是持续性和/或加重性不对称性的极好预测因子。因此，对于处于或高于这个 15/38 截止值的青少年男孩，观察而不进行治疗可能是不必要的。
