title: Testicular asymmetry and adolescent varicoceles managed expectantly.
abstract: OBJECTIVE
  Adolescent varicocele is often associated with testicular asymmetry. Depending on the degree of asymmetry, some physicians will recommend surgery. However, given the possibility that asynchronous growth may be transient, others advocate for a period of observation. We reviewed our outcomes in such patients who were initially treated expectantly.
  
  
  METHODS
  We retrospectively reviewed our pediatric varicocele database. We analyzed the outcomes of patients presenting for evaluation of varicocele who were followed with serial testicular volume measurements using scrotal ultrasound or ring orchidometry and who had at least a 6-month interval between measurements. Fisher's exact test was used to compare groups based on initial and final testicular asymmetry.
  
  
  RESULTS
  We identified 181 patients (median age 13.8 years) who were followed expectantly. Serial volume measurements had been obtained at a median interval of 12 months (interquartile range 8 to 21) between first and most recent visits. Mean percent asymmetry for the group did not change with time. Among patients who initially had less than 20% asymmetry 35% had 20% or greater asymmetry on followup, and among those with 20% or greater asymmetry initially 53% remained in that range (p = 0.007).
  
  
  CONCLUSIONS
  Asymmetry can be a transient phenomenon. Patients with initial asymmetry can end up with significant asymmetry, and many with significant asymmetry can have catch-up growth. However, when patients have a peak retrograde flow of 38 cm per second or greater on duplex Doppler ultrasound in association with 20% or greater asymmetry spontaneous catch-up growth is unlikely to occur.
authors.affiliation: 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.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Poon
authors.forename: Carl K
authors.initials: CK
authors.lastname: Gjertson
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Mercado
authors.forename: Peter M
authors.initials: PM
authors.lastname: Raimondi
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Kozakowski
authors.forename: Kenneth I
authors.initials: KI
authors.lastname: Glassberg
mesh_terms: D000293:Adolescent; D000013:Congenital Abnormalities / Q000628:therapy; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013737:Testis / Q000002:abnormalities*; D014646:Varicocele / Q000150:complications*