Karl Coutinho1, Daryl McLeod1, Kristian Stensland2, Jeffrey A Stock1. 1. Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Urology, Kravis Children's Hospital at Mount Sinai, New York, NY, USA. 2. Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Urology, Kravis Children's Hospital at Mount Sinai, New York, NY, USA. Electronic address: Kristian.stensland@mssm.edu.
Abstract
OBJECTIVE: Our study aims to evaluate variations in management of asymptomatic adolescent grade 2 and 3 varicoceles by pediatric urologists. SUBJECTS AND METHODS: Electronic survey of all 267 current members of AAP Urology with 74 (28%) responding. RESULTS: When managing patients with positive examination findings, 49% of surveyed practitioners use scrotal sonography as initial screening, while 38% use only manual orchidometry and 11% observation with serial examinations. If significant testicular size discrepancy is identified, 32% immediately intervene surgically, while 59% repeat measurements in 6-12 months. When no discrepancy is identified, 36.6% of practitioners discharge their patients with no follow-up, 22.5% refer to an infertility specialist, and 31% evaluate with semen analysis. Fifty-seven percent of practitioners have never sent patients for semen analysis; only 4% send >50% of patients. Of these, 52% and 27% analyzed semen at 17-18 years and 19-20 years, respectively, and 10% send for semen analysis at <17 years. CONCLUSIONS: Our survey demonstrates that there does not appear to be a consensus among pediatric urologists managing asymptomatic grade 2 and 3 varicoceles. Better understanding of which adolescent patients with varicoceles will go on to develop male infertility is necessary to identify pediatric patients who could benefit from early intervention.
OBJECTIVE: Our study aims to evaluate variations in management of asymptomatic adolescent grade 2 and 3 varicoceles by pediatric urologists. SUBJECTS AND METHODS: Electronic survey of all 267 current members of AAP Urology with 74 (28%) responding. RESULTS: When managing patients with positive examination findings, 49% of surveyed practitioners use scrotal sonography as initial screening, while 38% use only manual orchidometry and 11% observation with serial examinations. If significant testicular size discrepancy is identified, 32% immediately intervene surgically, while 59% repeat measurements in 6-12 months. When no discrepancy is identified, 36.6% of practitioners discharge their patients with no follow-up, 22.5% refer to an infertility specialist, and 31% evaluate with semen analysis. Fifty-seven percent of practitioners have never sent patients for semen analysis; only 4% send >50% of patients. Of these, 52% and 27% analyzed semen at 17-18 years and 19-20 years, respectively, and 10% send for semen analysis at <17 years. CONCLUSIONS: Our survey demonstrates that there does not appear to be a consensus among pediatric urologists managing asymptomatic grade 2 and 3 varicoceles. Better understanding of which adolescent patients with varicoceles will go on to develop male infertility is necessary to identify pediatric patients who could benefit from early intervention.