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Varicocele in Prepubertal Boys
Michael Kurtz, MD1, Ilina Rosoklija, MPH2, Greta Kringle, BA2, Richard Yu, MD, PhD2, David Diamond, MD2.
1Massachusetts General Hospital, Boston, MA, USA, 2Boston Childrens Hospital, Boston, MA, USA.

BACKGROUND: The pediatric varicocele is a common condition with a prevalence of approximately 15% in adolescent males. The unique problem of varicocele presenting in boys before the onset of puberty has not been thoroughly studied and there is little data to guide the clinician. To our knowledge only 3 studies have presented longitudinal follow-up of varicoceles in prepubertal boys, comprising a total of 30 subjects. We sought to examine the natural history of varicocele in this population.
METHODS: METHODS: We retrospectively reviewed the records of 31 boys at Children's Hospital Boston who had a documented Tanner stage of 1, right testis orchidometric volume < 3 cc's, or ultrasound right testes volume < 3 cc's. Disparate testis size, or hypotrophy, was defined as a volume difference of greater than 10%, right greater than left. A second cohort of postpubertal boys with varicocele was matched to the prepubertal subjects using initial testis size disparity. The mean difference in intial disparity between each matched pair of pre- and post-pubertal boys was 1.3%.
RESULTS: In the prepubertal cohort median age was 10.9 years (range 6.7-13.4), mean varicocele grade was 2.58, length of follow-up was 2.92 years, and mean right testis size was 1.96 cc's at presentation. Eleven boys presented with a hypotrophic left testis; of these three resolved without intervention, two failed to resolve the disparity, two underwent operation for hypotrophy, and four underwent operation for other indications. 20 boys presented with symmetrical testis size; of these 10 remained symmetric at follow-up, three progressed to hypotrophy, four underwent operation for new development of hypotrophy, and 3 underwent operation for other indications.
In the pubertal/post-pubertal cohort mean length of follow-up was 2.73 years and mean varicocele grade was 2.61.
For those boys beginning with symmetric testis size, there was no difference in the prepubertal and pubertal/post-pubertal cohorts comparing those ending with symmetry versus those with hypotrophy or having operations for hypotrophy (mean difference of 0%, 95%CI {-0.93 - 0.93 } p=0.99). For those boys beginning with asymmetric testis size, there was a slight trend toward a higher rate of ending with symmetry in the pubertal/post-pubertal group (42% more likely to be symmetric or not have an operation for asymetry, 95%CI {0.05-0.8} p=0.03)
CONCLUSIONS: In this retrospective case series at nearly 3 years of follow-up nearly half of the prepubertal boys with varicocele did not require operation or have hypotrophy. Testicular size discrepancy at diagnosis in pre- and post-pubertal males is associated with a lower likelihood of symmetry over three years of follow-up. Hypotrophy at presentation appears to results in equivalent outcomes when comparing the pre-pubertal and post-pubertal groups.


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