Login to Access Video or Poster Abstract: MP66-19
Sources of Funding: None

Introduction

Treatment of pediatric varicoceles remains controversial. Generally, observation is the preferred approach, with surgery reserved for patients with pain, testicular hypotrophy or abnormal semen parameters. However, the utility of varicocelectomy has been disputed due to studies showing spontaneous improvement in testicular size with observation and unreliability of semen studies in adolescents. This uncertainty may have affected surgical practice patterns and we sought to analyze trends of varicocelectomy in New York State over the past 12 years.

Methods

The New York Statewide Planning and Research Cooperative System (SPARCS) database was queried for boys <18 years-old who underwent varicocelectomy from 2003 to 2014. Patients were identified using ICD-9-CM procedural codes (631) and CPT codes (55530, 55535, 55540, and 55550), and were then divided by approach (inguinal, abdominal, laparoscopic). Rates of surgery were adjusted by yearly state population of boys <18 years-old using census data (census.gov). Trends were estimated using the method of least squares, and goodness of fit was determined using the R² coefficient.

Results

A total of 3,927 patients were identified who underwent varicocele repair between 2003 and 2014 in New York State. Median age at surgery was 15 years. 68.6% of patients were white. Most procedures were done in New York City (54.4%), and almost all were by inguinal (57.3%) or laparoscopic (30.9%) approaches. Annual rate of varicocelectomy declined by 0.57 cases per 100,000 boys per year (slope = -0.57, R² = 0.72; Figure 1) from 16 cases/100,000 in 2003 to 9 cases/100,000 in 2014. The decrease in inguinal approach accounted for the majority of this trend (slope = -0.55, R²=0.94), from 11 cases/100,000 in 2003 to 4 cases/100,000 in 2014. Laparoscopic and abdominal approaches remained stable.

Conclusions

The rate of pediatric varicocelectomy performed in New York State significantly dropped over the last 12 years, particularly the inguinal approach. Contrary to studies showing stable rates of varicocelectomy performed at Children&[prime]s Hospitals (Harel, 2015), we found a consistent decline across academic and community centers. Further study is required to identify factors that have driven the nearly 50% decline in surgery and to better define indications for intervention.

Funding

None