title: The validity of testicular catch-up growth and serum FSH levels in the long-term postoperative assessment of laparoscopic varicocele correction in adolescents.
abstract: BACKGROUND
  Postoperative assessment after varicocele surgery in adolescence is commonly centred around catch-up growth of the testis. There is paucity of evidence on the correlation of catch-up growth with underlying testicular function in these patients.
  
  
  OBJECTIVE
  To assess the reliability of catch-up growth of the testis as an indicator of normalization of testicular function and the utility of serum FSH levels in the long-term postoperative assessment of varicocele surgery in adolescence.
  
  
  METHODS
  Prospective cohort study of young adults (18-27 years) who had laparoscopic varicocele correction in adolescence (11-16 years). Evaluation included serum FSH levels, scrotal ultrasonography and semen analysis.
  
  
  METHODS
  Anatomical and functional parameters of participants with equal and normal testicular size were compared to those of participants with persistent testicular hypotrophy or hypertrophy. Sensitivity and positive predictive value of postoperative serum FSH levels were estimated and elevated levels of serum FSH were checked for association with suboptimal outcomes of varicocele correction.
  
  
  RESULTS
  The serum FSH levels of participants with unequal testicular sizes (n=6, median 6.65 IU/l), which included testicular hypertrophy (n=3, median 7.2 IU/l) and persistent testicular hypotrophy (n=3, median 6.1 IU/l), were significantly higher than the group with equal testicular sizes (n=8, median 3.5 IU/l; P=0.014, Mann-Whitney U test). Postoperative elevated serum FSH levels were significantly associated with suboptimal outcomes of varicocele surgery (P=0.015, Fisher's exact test). The test also had a high positive predictive value.
  
  
  CONCLUSIONS
  Testicular catch-up growth may not be a reliable postoperative assessment criterion by itself. Serum FSH levels may be of value in detecting suboptimal outcomes of varicocele surgery in adolescents.
authors.affiliation: Department of General Surgery, The Children's Hospital at Westmead, Westmead, NSW; The University of Sydney, Australia.
authors.forename: Aniruddh
authors.initials: A
authors.lastname: Deshpande
authors.forename: Ralph
authors.initials: R
authors.lastname: Cohen
authors.forename: Irene
authors.initials: I
authors.lastname: Tsang
authors.forename: Geoff
authors.initials: G
authors.lastname: Ambler
authors.forename: Steven
authors.initials: S
authors.lastname: Fleming