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17839

The Relationship Between BMI and Varicoceles In Children

Saturday, October 20, 2012
Grand Ballroom A/B (Hilton Riverside)
Aaron Krill, MD1, Suzanne Sunday, PhD1, Jordan Gitlin, MD1, Jaime Freyle, MD2, Steven Friedman, MD2 and Lane S. Palmer, MD, FAAP1, (1)Pediatric Urology, Cohen Children's Medical Center of NY, New Hyde Park, NY, (2)Urology, Maimonides Medical Center, Brooklyn, NY

Purpose

Among adult men with varicoceles, several studies demonstrate lower BMI compared to controls and a negative correlation between BMI and grade. Only one study evaluated the physical characteristics of children with varicoceles, reporting them to be taller and heavier with normal BMI percentiles; however, patients were not stratified by grade. The purpose of our study was to evaluate whether a decreasing BMI percentile was associated with an increase in varicocele grade and testis hypotrophy.

Methods

We reviewed records of all patients seen for varicoceles from 2007-2011. The following data were collected at first visit for patients <20 years old with left-sided varicoceles:  varicocele grade, sonographic measurements, and height and weight.  Exclusion criteria were: prior inguinal surgery, cryptorchidism, or endocrine disorders.  Testis volume was determined by Lambert's formula. Testis asymmetry was calculated via(larger-smaller/larger).  Age-based BMI percentiles from CDC growth curves were analyzed in relation to grade, Tanner stage and testis asymmetry (≥ 20% versus < 20%). ANOVA, Chi square/Fischer exact test and Pearson correlations were used where appropriate.

Results

575 boys with a mean age of 14.8 ± 2.2 were included. Grade distribution was:  1-68(11.8%), 2- 291(50.6%) and 3-216(37.6%). BMI percentiles for decreased significantly with increasing grade(see table). More boys with grade 3 varicoceles were underweight versus boys with grades 1 and 2. 33.8% of grade 1 patients were overweight, versus 18% and 11% of grades 2 and 3 (p<0.0001). Testis asymmetry was related to grade: 31% of grade 3 and 20.6% of grades 1 and 18.6% of grade 2 (p=0.004). There was no correlation between BMI and testis symmetry overall. Tanner stage 3 showed an association between declining BMI percentile and increasing asymmetry(r=-0.35, p=0.0027).

Conclusion

Mean BMI percentiles for each group were within “normal healthy weight”, but children with grade 3 varicoceles were more likely to be underweight, less likely to be overweight, and more likely to have testis asymmetry than grades 1 and 2. Only at Tanner stage 3 was declining BMI percentile linked to testis asymmetry. Observations in adults linking varicocele severity and body type are applicable to adolescents with grades 2 and 3 being leaner than those with grade 1.

 

 

 

Cohort

Grade 1

Grade 2

Grade 3

P value

Age

14.8 +/- 2.15

14.86 +/- 2.42

14.75 +/- 2.23

14.86 +/- 1.97

NS

>20% Testis asymmetry

135(23.5%)

14(20.5%)

54(18.5%)

67(31%)*

<0.05

BMI

20.78 +/- 3.7

22.57 +/-5.1

20.93 +/- 3.5

20.01 +/- 3.21

NS

BMI percentile

54.2 +/- 28.3

65.2 +/- 27.63

56.78 +/- 27.11

47.35 +/- 28.53

0.005

% Underweight

(<5th%)

21(3.6%)

1(1.5%)

6(2%)

14(6.5%)

<0.05

% Normal weight

(5th-85th%)

454(78.9%)

44(64.7%)

232(79.7%)

178(82.4%)

NS

% Overweight (≥85th%)

100(17.3%)

23(33.8%)

53(18.2%)

24(11.1%)

<0.0001