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Measurement of testicular volume is a more readily available method of estimating spermatogenesis in adolescence. Traditionally, testicular volumes have been measured with different type of orchidometers or calipers. The most widely used orchidometer is the Prader orchidometer introduced in 1966. This type of orchidometer, a graded series of ellipsoid beads on a string, is used for testicular volume measurement, which is a useful index of puberty in male in order to evaluate male growth and development. Although it is more practical and inexpensive compared with ultrasonography, this instrument has been questioned in regard to its objectiveness in different hands. We designed a prospective clinical study to investigate the correlation between testicular size measurements of three different clinical investigators by using Prader orchidometer. A total of 100 testes in 50 boys with a mean age of 6.4 years (range 1-15 years) who presented to Urology and Pediatrics outpatient clinics of our hospital without urogenital complaints were enrolled to this study. The volumes of each testis were measured independently using Prader orchidometer by three different clinical investigators (A, B and C). Each investigator repeated testicular volume measurements blinded to measurements obtained by others. The measured volumes were recorded separately. Statistical analysis of the results was performed using Pearson's correlation (r) to determine the correlation of orchidometer measurements between the examiners. All statistical analyses and power calculations were performed using computer software. Mean testicular volumes measured by three examiners A, B and C were 4.01+/-3.79 ml (SD) (2-18 ml), 3.66+/-3.46 ml (SD) (1-18 ml) and 3.86+/-3.54 ml (SD) (1-18 ml), respectively. The statistical correlation between the measurements of investigator A and B, A and C, and B and C showed a high correlation {r = 0.954 (P0.01), r = 0.964 (P0.01), and r = 0.979 (P0.01)}, respectively. In the present study, it was shown that testicular size measurement by using Prader orchidometer gives good correlation in different examiners' hands and it is an objective and reliable method in pediatric urological practice.

The Palomo procedure has often been criticized with regard to possible atrophy of the testis. Measuring the testicular volume is mainly used in pre- and postoperative assessment. Evidence concerning fertility remains unclear. The aim of this study was to learn whether now-adult former patients had any disturbance of their testicular growth and/or fertility. Out of 79 patients operated upon with Palomo's procedure between 1979 and 1990, 33 could be evaluated. They all had grade II or III left-sided varicoceles. Investigations consisted of: the patient's history, testicular-volume measurement by means of an orchidometer (OM) (Prader) and ultrasonography (US), and semen analysis (27/33) 6–17 years after surgery. No recurrence of grade II varicoceles was observed. Only 1 of the 33 patients might have had testicular atrophy, yet he had already fathered 3 children! Twenty-three had a normal sperm count and 24/27 showed normal sperm motility. Eight hydroceles were either present at the time of investigation or had been operated upon in the past. Estimations of testicular volume by OM and US showed significant differences between the two methods concerning volume and relation of right to left side. In general, the volume was overestimated by the OM. The study shows that in boys the simple surgical technique proposed by Palomo has – in the long run – no disadvantages for testicular development and sperm production. Fertility should therefore not be compromised.

Several reports with conflicting results have been published describing the incidence of testicular lesions resulting from incarcerated inguinal hernia. At the Department of Pediatric Surgery of the University of Graz, 178 children were treated for 180 incarcerated inguinal hernias from 1978 to 1985; 124 infants with suspected testicular lesions were followed up in 1984. The size of the testicles was determined using the Prader of the testicles was determined using the Prader orchidometer and comparing both testicles. In 18 children (14.4%) distinct testicular lesions were found. Infants less than 2 months old showed a significantly higher incidence of testicular lesions than older children (33.3% vs. 6.8%). Children in whom operative reduction of the incarcerated hernia was necessary had a significantly higher incidence of testicular atrophy than children in whom preoperative reduction was successful (29.0% vs. 9.6%). Our study shows that risk factors such as age, time of reduction, histologically proven hemorrhagic infarction, and undescended testis are of prognostic value.