Testicular growth arrest and adolescent varicocele: does varicocele size make a difference?

We assessed whether testicular growth arrest is related to varicocele size in adolescents. We also determined whether adolescents with a varicocele and testes of equal size treated nonoperatively are at significant risk for growth arrest and, if so, whether this risk is related to varicocele size.

We retrospectively reviewed the records of boys with a varicocele. Testis volume was measured with calipers and computed into cc as (length x width x breadth) x 0.521. Testicular growth arrest was defined as left testis at least 15% smaller than the right testis. Varicocele size was graded 1-barely palpable, 2-palpable but not visible, 3a-visible and, 1 to 1.5 times the size of the ipsilateral testis, 3b-1.5 to 2 times the size of the ipsilateral testis and 3c-greater than 2 times the size of the ipsilateral testis. Boys with a grade 1 varicocele and those treated with previous inguinal or testicular surgery were excluded from study. Repair was recommended for testicular growth arrest or discomfort. Data were analyzed with chi-square and Fisher's exact test.

The records of 124 boys 7 to 18 years old (mean age 13) with a varicocele were reviewed. Seven patients were excluded from analysis, yielding a total of 117 boys. Testicular growth arrest was observed at initial visit in 10 of 33 (30.3%) grade 2, 18 of 37 (48.6%) grade 3a, 14 of 31 (45.2%) grade 3b and 6 of 16 (37.5%) grade 3c cases (p not significant), or a total of 38 of 84 (45.2%) grade 3 cases (p <0.01) plus grade 2. Followup ranged from 1 to 5 years. Of the cases of equal sized testes at presentation growth arrest was observed in 3 of 16 (18.8%) grade 2, 2 of 11 (18.2%) grade 3a, 4 of 14 (28.6%) grade 3b and 3 of 9 (33.3%) grade 3c (p not significant), or a total of 9 of 34 (26.5%) grade 3 cases (p not significant) plus grade 2. Overall, testicular growth arrest was found in 13 of 33 (39%) grade 2 and 47 of 84 (56%) grade 3 varicoceles (p <0.01).

Boys with a varicocele are at significant risk for testicular growth arrest, irrespective of varicocele size, and those with a grade 3 varicocele have a higher risk of testicular growth arrest than those with a grade 2 varicocele. Of boys with testes of equal size at diagnosis growth arrest is observed during adolescence in approximately 25% irrespective of varicocele size.