Adolescent Varicocelectomy - Is The Potential For Catch-Up Growth Related To Age And/or Tanner Stage?

Main Category: Urology / Nephrology
Also Included In: Pediatrics / Children's Health
Article Date: 05 Apr 2009 - 4:00 PDT

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UroToday.com - Typically, catch-up growth following varicocelectomy is one of the parameters used to assess the efficacy of surgery. There has always been debate whether this represents true testicular growth or increased interstitial fluid secondary to lymphatic obstruction.

Dr. Stephen Poon, et al retrospectively reviewed the outcomes of 136 boys (mean age 15.1 years) who had 10% or greater preoperative testicular asymmetry and underwent varicocelectomy between 1997 and 2006. Surgery was either a laparoscopic nonlymphatic sparing or laparoscopic lymphatic sparing varicocelectomy. All patients had pre- and postoperative ultrasound volume measurements at least 6 months following surgery. The groups were compared for incidence of postoperative catch-up growth, achieving less than 10% testicular asymmetry.

The researchers found that after a mean follow up of 24.7 months, catch-up growth was achieved in 62.8% of patients. There was no significant difference between the groups in regard to catch-up growth (51.7% vs. 66.3%, P = 0.193). The group then went on to conclude that since no significant difference was found between the laparoscopic sparing and nonlymphatic sparing varicocelectomies, lymphatic obstruction is not the cause of catch-up growth.

It is interesting that the growths are equal, but it is difficult to ensure that all the lymphatics have been spared and one truly has to answer the question: How many lymphatics does it take to reach a critical mass to cause lymphatic blockage? I doubt we will ever know the answer to that question.

I also pose the question: How many of these children would have had catch up growth just with observation? The average age was 15 years, so how many would have had an abnormal semen analysis at age 17 or 18 years? Without preoperative and postoperative semen analysis, we can debate these findings for an eternity.

Decastro GJ, Shabsigh A, Poon SA, Laor L, Glassberg
J Urol. 2009 Jan;181(1):322-7
10.1016/j.juro.2008.09.037

Written by UroToday.com Medical Editor Pasquale Casale, MD

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