| Peak retrograde flow: a novel predictor of persistent, progressive and new onset asymmetry in adolescent varicocele. | |
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MedLine Citation:
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PMID: 19375756 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: The major indication for adolescent left varicocelectomy is testicular asymmetry. However, a period of observation is often recommended preoperatively to determine if the asymmetry resolves, persists or progresses. We investigated whether varicocele grade or the duplex Doppler ultrasound measurements of peak retrograde flow and mean vein diameter could be used as predictors of persistent, progressive or new onset asymmetry. MATERIALS AND METHODS: Only patients with left varicoceles who had undergone at least 2 duplex Doppler ultrasounds without intervening surgery were included in the study. Grade of varicocele, peak retrograde flow and mean vein diameter were analyzed as possible determinants of catch-up growth, or persistent or new onset asymmetry. RESULTS: A total of 77 patients (mean age 14.3 years, range 9 to 20) were identified with a mean observation period of 13.2 months. Of the patients 50 (65%) had 10% or greater asymmetry at the first measurement. Of patients with initial 20% or greater asymmetry 71% had persistent or worsening asymmetry on followup evaluation. All 14 patients with the combination of an initial peak retrograde flow 38 cm per second or greater and 20% or greater asymmetry had progressive asymmetry on followup examination. Peak retrograde flow was the only significant parameter of predictive value for persistent or worsening asymmetry (p = 0.032). CONCLUSIONS: Peak retrograde flow can serve as a valuable tool in predicting persistent, progressive and new onset asymmetry. Varicoceles associated with a peak retrograde flow of 38 cm per second or greater and 20% or greater asymmetry should be considered for varicocelectomy at initial presentation. Patients with peak retrograde flow greater than 30 cm per second need to be monitored carefully. Those with peak retrograde flow less than 30 cm per second are less likely to require surgery. |
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Authors:
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Kristin A Kozakowski; Carl K Gjertson; G Joel Decastro; Stephen Poon; Anthony Gasalberti; Kenneth I Glassberg |
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Publication Detail:
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Type: Journal Article Date: 2009-04-17 |
Journal Detail:
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Title: The Journal of urology Volume: 181 ISSN: 1527-3792 ISO Abbreviation: J. Urol. Publication Date: 2009 Jun |
Date Detail:
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Created Date: 2009-05-11 Completed Date: 2009-06-22 Revised Date: 2009-11-13 |
Medline Journal Info:
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Nlm Unique ID: 0376374 Medline TA: J Urol Country: United States |
Other Details:
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Languages: eng Pagination: 2717-22; discussion 2723 Citation Subset: AIM; IM |
Affiliation:
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Department of Urology, Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University, College of Physicians and Surgeons, New York, New York 10032, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Child Disease Progression Humans Male Regional Blood Flow* Retrospective Studies Testis / blood supply*, pathology*, ultrasonography Ultrasonography, Doppler Varicocele / pathology*, physiopathology*, ultrasonography Young Adult |
| Comments/Corrections | |
Comment In:
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J Urol. 2009 Jun;181(6):2418-9
[PMID:
19371888
]
J Urol. 2009 Dec;182(6):2985 [PMID: 19846126 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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