de Wachter, Stefan

De Win, Gunter

Leysen, Cynthia

Lourdaux, Pieter\u2010Jan

Vagan\ue9e, Donald

Abstract: Objectives To assess the evolution of the Testicular Atrophy Index (TAI) in adolescent boys with and without a left varicocele with special attention for the currently postulated cut-off value of 20%. Subjects and Methods During 2015\u20132019, 364 adolescent boys aged 11\u201316\u2009years were recruited. Genital examination and scrotal ultrasonography were repeatedly performed ( 654\u2009month intervals). Testicular volume (TV) was calculated using the Lambert formula (length\ua0
7\ua0width\ua0
7\ua0height\ua0
7\u20090.71). TAI was calculated using the formula: [(TVright\ua0 12\ua0TVleft)/TVlargest (right, left)]\ua0
7\u2009100. Results The final study population comprised 239 participants, 161 (67.36%) controls and 78 (32.64%) adolescent boys with left varicocele. The mean (sd) number of measurements per participant was 3.82\ua0(1.08). A TAI of  6520% at first measurement occurred in 9.94% and 35.90%, respectively. Of these, only 31.25% and 46.43% had a TAI of  6520% at the last measurement, respectively. Nevertheless, the risk of ending up with a TAI of  6520% was significantly higher if a TAI of  6520% was recorded at first measurement (P\ua0=\u20090.041 and P\ua0=\u20090.002, respectively). The normalisation rate did not differ significantly between the groups (P\ua0=\u20090.182). Normalisation occurred most frequently in Tanner Stages III and IV. Normalisation was mostly ( 6574%) due to catch-up growth of the left testis, in contrast to growth retardation of the right testis, in both groups. The TAI seems to be a fluctuating parameter. Conclusion A TAI of  6520% is a phenomenon seen in boys with and without varicocele but is more common in boys with varicocele. Although normalisation of a high TAI is frequently seen, both adolescent boys with and without a left varicocele who have an initial TAI of  6520% have a higher risk of a TAI of  6520% in the future. As the TAI is a fluctuating parameter during pubertal development, it's use as indicator for varicocelectomy based on a single measurement during pubertal development is questioned

Evolution of testicular asymmetry during puberty in adolescents without and with a left varicocele

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