title: Diagnosis of pediatric varicoceles by physical examination and ultrasonography and measurement of the testicular volume: using the prader orchidometer versus ultrasonography.
abstract: BACKGROUND
  The differentiation of unilateral versus bilateral varicoceles and testicular volume measurements are important in determining the need for adolescent varicocele surgery and also in following patients after varicocelectomy. The aim of this study was to prospectively compare the findings of physical examination and color Doppler ultrasonography in the diagnosis of pediatric varicoceles and to compare the findings using the Prader orchidometer and scrotal ultrasonography in the measurement of testicular volumes.
  
  
  METHODS
  This study included 68 boys with varicoceles, ranging in age from 8 to 19 years. Varicoceles were diagnosed using both physical examination and scrotal color Doppler ultrasonography. The testicular volumes of 136 testicles were measured using the Prader orchidometer and scrotal ultrasonography. A difference of more than 10% or 2 ml in each testicular volume was considered significant.
  
  
  RESULTS
  The mean age of the boys was 13.5 +/- 2.3 years. On physical examination, a left unilateral varicocele was diagnosed in 46 boys (67.6%). The other 22 boys (32.4%) had bilateral varicoceles. Color Doppler ultrasonography detected bilateral varicoceles in 4 of the 46 boys (8.7%) who were diagnosed by physical examination as having only left unilateral varicoceles (grade 3 in 3 patients and grade 2 in 1 patient). A different of more than 10% or 2 ml in testicular volume using the Prader orchidometer versus scrotal ultrasonography was detected in 3 out of 136 testicles (2.2%). The correlation between ultrasonography and Prader orchidometer results in the measurement of testicular volumes was statistically highly significantly consistent using the intraclass correlation test (r = 0.997 and p < 0.001 for the left testis; r = 0.998 and p < 0.001 for the right testis).
  
  
  CONCLUSIONS
  Although the management of subclinical varicoceles remains controversial, these data show that color Doppler ultrasonography may be necessary in the diagnosis of bilateral varicoceles, especially in boys with high-grade left varicoceles. In contrast, scrotal ultrasonography, if considered the gold standard, did not show superiority over the Prader orchidometer in measuring testicular volumes.
authors.affiliation: Department of Urology, University of Mersin School of Medicine, Mersin, Turkey.selcayan@mersin.edu.tr
authors.forename: Selahittin
authors.initials: S
authors.lastname: Cayan
authors.forename: Erdem
authors.initials: E
authors.lastname: Akbay
authors.forename: Murat
authors.initials: M
authors.lastname: Bozlu
authors.forename: Erdal
authors.initials: E
authors.lastname: Doruk
authors.forename: Altan
authors.initials: A
authors.lastname: Yildiz
authors.forename: Deniz
authors.initials: D
authors.lastname: Acar
authors.forename: E Arzu
authors.initials: EA
authors.lastname: Kanik
authors.forename: Ercüment
authors.initials: E
authors.lastname: Ulusoy
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D006801:Humans; D008297:Male; D010808:Physical Examination; D011446:Prospective Studies; D013737:Testis / Q000000981:diagnostic imaging* / Q000473:pathology*; D014463:Ultrasonography; D014646:Varicocele / Q000000981:diagnostic imaging* / Q000473:pathology*