(088) TRENDS IN VARICOCELE SURVEILLANCE AND SURGICAL INTERVENTION IN CHILDREN AND ADOLESCENTS

Abstract Introduction Varicocelectomy is often recommended in the setting of abnormal semen analyses, testicular atrophy, or associated testicular discomfort. Managing varicoceles in the adolescent populations is less clear because of the unknown impact on fertility. Expert consensus recommends adolescent patients diagnosed with varicocele undergo further evaluation to assess testicular growth. Varicocele surveillance trends including prevalence, length of follow-up, and indications for intervention are underreported. We report our experience with varicocele surveillance and the triggers for surgical intervention in the pediatric population at our institution. Objective We aim to characterize the selection of adolescent patients with varicocele participating in surveillance and the triggers for proceeding to varicocelectomy. Methods A single institutional retrospective review of electronic medical records from a tertiary referral center was performed. We evaluated pediatric patients ≤18 years old diagnosed with varicocele from 5/1/1993 to 5/31/2023. Varicocele diagnosis was identified using ICD 9 and 10 codes. Surveillance was defined as having at least one additional encounter for varicocele evaluation following the initial diagnosis. Testicular volumes were obtained by scrotal ultrasound and clinical assessment. Results 96% of patients (380 of 395) had no varicocelectomy. 209 (53%) patients participated in surveillance. 9 of these patients eventually had a varicocelectomy. Indications for surgery in patients being surveilled included testicular pain (n = 4), testicular volume difference (n = 3 with a median testicular volume difference of 2.7 mL), and 2 patients with no reported indication. 186 (47%) patients had no surveillance period, 6 of which had a varicocelectomy. Indications for surgery in these patients included testicular pain (n = 2), testicular volume difference (n = 3 with a median testicular volume difference of 2.4 mL), and bilateral testicular hypotrophy (n = 1) with a total testicular volume of 10 mL. The median age at diagnosis was 15.05 years in the surveillance group and 15.5 years in the non-surveillance group. Conclusions Following diagnosis, only half of children and adolescent patients participated in surveillance of their varicocele. Rates of boys proceeding to varicocelectomy were very low and did not differ between patients seen at the primary visit and those who were followed for their varicocele. Our findings highlight the importance of maximizing patient counseling about varicoceles at diagnosis. Surveillance of young males with varicoceles requires patient, guardian, and provider education to counsel patients who may not otherwise undergo evaluation until infertility is encountered. Disclosure No.