Albert Einstein College of Medicine, NY, USA.
Montefiore Medical Center, NY, USA.
Int Braz J Urol. 2018 Sep-Oct;44(5):981-986. doi: 10.1590/S1677-5538.IBJU.2017.0652.
We evaluated the relationship between total testicular volume (TTV) and testicular volume differential (TVD) in adolescent males with varicocele. Both low TTV and high TVD have been independently associated with higher incidences of infertility later in life, but a predictive relationship between TTV and TVD directly has yet to be described.
We retrospectively analyzed a database of Tanner 5 boys ages 16-21 who presented with varicocele at a single institution between 2009 and 2017. All patients had a scrotal sonogram prior to surgical intervention. TTV and TVD were calculated for each individual and four non-exclusive groupings of patients were created for statistical analysis. We chose 30 cc as a cut off value for low TTV based on prior studies.
209 patients met our inclusion criteria. Mean age was 18.3 years (16-21, SD 1.7) with a mean total testicular volume of 36 cc (13.5-78.2, SD 11.1). Cut off points of TVD of 20% and TTV of 30 cc were used to separate patients. There were 65 boys (31%) with TTV < 30 cc and 58 boys (28%) with TVD ≥ 20%. Among males with TTV < 30 cc, 23 (35%) had a TVD ≥ 20%. Among males with TTV ≥ 30 cc, 35 (24%) had a TVD ≥ 20%. The relationship between TVD and TTV was found to be non-significant (p > 0.05).
Adolescent varicoceles continue to pose a challenge to pediatric urologists. The dilemma of over-aggressive treatment has proven difficult to balance with the risk of infertility. We hoped that elucidating the relationship between TTV and TVD could be useful in identifying patients who are at greater risk for infertility while decreasing the need for more intrusive testing, such as semen analysis, in an adolescent population. We looked at the direct relationship between low TTV and high TVD. In our population, there was a non-significant relationship between TTV < 30 cc and TVD ≥ 20% (p > 0.05) indicating that in adolescents with varicocele, TTV and TVD are independent variables. Our study limitations include the inherent user dependent bias of ultrasound measurements and data collection at a single institution with high ethnic diversity, possibly not comparable to all patient populations.
Low TTV (< 30 cc) itself is not predictive of high TVD (≥ 20%) in adolescent boys with varicocele, despite their reported independent associations with impaired fertility in other studies.
我们评估了患有精索静脉曲张的青少年男性的睾丸总体积（TTV）和睾丸体积差异（TVD）之间的关系。低 TTV 和高 TVD 都与更高的不孕发生率有关，但 TTV 和 TVD 之间的直接预测关系尚未描述。
我们回顾性分析了 2009 年至 2017 年间在一家机构就诊的 16-21 岁的 Tanner 5 期男孩的数据库。所有患者在手术干预前均进行了阴囊超声检查。计算了每个个体的 TTV 和 TVD，并为统计分析创建了四个非排他性的患者分组。我们根据先前的研究选择 30cc 作为低 TTV 的截止值。
209 名患者符合纳入标准。平均年龄为 18.3 岁（16-21 岁，标准差 1.7），平均睾丸总体积为 36cc（13.5-78.2，标准差 11.1）。使用 TVD 20%和 TTV 30cc 的截断点来区分患者。65 名男孩（31%）的 TTV < 30cc，58 名男孩（28%）的 TVD ≥ 20%。在 TTV < 30cc 的男性中，有 23 名（35%）的 TVD ≥ 20%。在 TTV ≥ 30cc 的男性中，有 35 名（24%）的 TVD ≥ 20%。TVD 与 TTV 之间的关系无统计学意义（p>0.05）。
青少年精索静脉曲张仍然对小儿泌尿科医生构成挑战。过度积极治疗的困境与不孕风险之间的平衡一直难以实现。我们希望阐明 TTV 和 TVD 之间的关系有助于识别生育能力受损风险更高的患者，同时减少在青少年人群中进行更具侵入性的检测，如精液分析的需要。我们研究了低 TTV 和高 TVD 之间的直接关系。在我们的人群中，TTV < 30cc 和 TVD ≥ 20%之间没有统计学意义（p>0.05），表明在患有精索静脉曲张的青少年中，TTV 和 TVD 是独立变量。我们的研究局限性包括超声测量的固有用户依赖性偏倚以及在具有高度种族多样性的单一机构进行的数据收集，这可能与所有患者群体无法相比。
尽管低 TTV（< 30cc）和高 TVD（≥ 20%）在其他研究中与生育能力受损有关，但在患有精索静脉曲张的青少年男孩中，低 TTV 本身并不能预测高 TVD。
