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The following is a summary of “Size Matters: Total Testicular Volume Predicts Sperm Count in Tanner V Varicocele Patients,” published in the May 2024 issue of Pediatrics by Fang et al.

The prevalence of varicoceles among adolescent males ranges from 14% to 29%, with ongoing debate regarding its impact on fertility. Given the challenges in obtaining semen analyses (SA), objective fecundity measures are essential. This study aimed to explore the relationship between testicular volume differential (TVD), varicocele grade, total testicular volume (TTV), and seminal parameters, particularly total motile sperm count (TMSC).

The researchers conducted a retrospective review spanning 14 years at a single center involving 486 Tanner V adolescent males. Three hundred and four patients with palpable, non-operated left-sided varicoceles who underwent SA and ultrasound were included. Abnormal TMSC was defined by the World Health Organization 2010 criteria for minimal reference ranges. Multivariate logistic regression, receiver operating characteristic (ROC) analysis using Youden J-statistic, and descriptive statistics were employed.

Among 304 Tanner V adolescents (median age 18.0 years, median TTV 34.5cc, median TMSC 62.5 million/ejaculate), a TTV cutoff of 29.5cc predicted TMSC <9 million/ejaculate with a negative predictive value of 96.2% and odds ratio of 6.08 ([2.13-17.42], p<0.001). TVD greater than 20% did not reach statistical significance (OR 1.66, [0.41-6.62], p=0.50).

Individualized management plans are crucial in clinical practice. The findings suggest that older adolescents (17 or 18 years) with varicocele and a TTV below 29.5cc may benefit from earlier consideration of SA or surgical intervention. Conversely, those with normal TTV are at lower risk of abnormal SA. Younger patients with varicocele and TVD >20% may warrant close monitoring, deferring intervention until older ages for better TTV assessment. Given the limited predictive value of a single measurement in developing adolescents, continued monitoring and trending of patient data are emphasized. The study’s limitations include its retrospective nature and variability in correlating adolescent SA results with future paternity.

TTV less than 29.5cc markedly increased the odds of abnormal semen analysis and demonstrated a high negative predictive value. Ultrasound results can aid in risk stratification and guide discussions regarding the appropriateness of surgical intervention.

Source: sciencedirect.com/science/article/abs/pii/S1477513124002705