236 / 492
16:01 - 16:04
S18-7
(PP)
THE NATURAL HISTORY OF SEMEN PARAMETERS IN UNTREATED VARICOCELE
PATIENTS
Thomas KOLON, Stephen ZDERIC, Aseem SHUKLA, Arun SRINIVASAN, Gregory TASIAN, Dana WEISS, Christopher
LONG and Douglas CANNING
Childrens Hospital of Philadelphia, Pediatric Urology, Philadelphia, USA
PURPOSE
We assess the natural history of semen parameters in adolescent boys with a left varicocele followed nonsurgically.
MATERIAL AND METHODS
We reviewed adolescents with a unilateral left varicocele prior to surgery. Each had bilateral testicular volume
measurement through puberty. We followed boys nonsurgically if they were asymptomatic and had normal testicular
volumes (total and differential <20%). We obtained a semen analysis (SA) and measured total motile count (TMC) after
Tanner 5 development. We collected the SA after 2 days of abstinence and at least 3 months apart. We defined the SA
as “poor” if TMC was <20million. We excluded boys with history of inguinal/scrotal pathology, endocrinopathy, or
missing SA data.
RESULTS
217 consecutive patients had an initial SA. The average age was 17.8 years (14.8-21.4). We excluded 16 for history of
cryptorchidism or incomplete SA data. 111 had an initial “good” SA and 90 had a “poor” SA regardless of varicocele
grade or testicular volumes. Of those with an initially “poor” SA, 52 had repeat SA and 23 patients improved to “good”.
Of the 29 with “poor” SA on 2 successive samples, 13 had one more SA and 7 improved to “good”. Thus, 55% had a
normal TMC after an initial SA, 66% after a second, and 68% after a third SA.
CONCLUSIONS
Two-thirds of Tanner 5 boys with an uncorrected varicocele achieve a normal TMC regardless of varicocele grade or
testicular volumes. Despite Tanner 5 development, 46% with an initial “poor” SA will improve to “good” status without
surgery.