Objective
To determine whether the varicocele grade is related to the degree of improvement
in serum testosterone levels after varicocelectomy.
Materials and Methods
We performed a retrospective review of men with a total serum testosterone level <400
ng/dL who had undergone microsurgical subinguinal varicocelectomy for infertility
and/or hypogonadism. All men had clinically palpable left varicoceles and preoperative
and postoperative total serum testosterone levels available. For patients with bilateral
varicoceles, the greatest grade on either side was used to stratify the patients.
The men with an isolated, left-side, grade I varicocele were not offered varicocelectomy.
The changes in the testosterone levels were evaluated, with the results expressed
as the mean ± standard error. P ≤.05 was considered statistically significant.
Results
A total of 59 patients had undergone bilateral varicocelectomy and 19 unilateral varicocelectomy.
Overall, an increase in testosterone was seen in 65 of the 78 men (83%) in the present
study. The mean follow-up was 7 months. The mean serum testosterone level increased
from 308.4 to 417.5 ng/dL, with a mean increase of 109.1 ± 12.8 ng/dL (n = 78). The
improvements in the serum testosterone levels were seen regardless of the clinical
grade.
Conclusion
Microsurgical varicocelectomy resulted in significant increases in the serum testosterone
level, independent of the varicocele grade.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Loss of fertility in men with varicocele.Fertil Steril. 1993; 59: 613-616
- Varicocele, age, and fertility.Lancet. 1957; 273: 222
- Progressive testicular atrophy in the varicocele patient.J Urol. 1977; 117: 175-176
- Varicocele: temporal considerations.J Urol. 1985; 134: 411-413
- Reversal of testicular growth failure by varicocele ligation.J Urol. 1987; 137: 475-476
- Testicular and vascular changes in children and adults with varicocele.J Urol. 1989; 142 ([discussion: 603-605]): 583-585
- Pathophysiology of varicocele in nonhuman primates: long-term seminal and testicular changes.Fertil Steril. 1986; 46: 500-510
- Deterioration of semen parameters over time in men with untreated varicocele: evidence of progressive testicular damage.Fertil Steril. 1992; 57: 174-177
- Varicocele: a progressive or static lesion?.Urology. 1993; 42: 541-543
- Anatomical approach to varicocelectomy.Semin Urol. 1992; 10: 242-247
- Varicocelectomy: 986 cases in a twelve-year study.Urology. 1977; 10: 446-449
- The effect of varicocelectomy on serum testosterone levels in infertile men with varicoceles.J Urol. 1995; 154: 1752-1755
- Effect of microsurgical varicocelectomy on human sperm chromatin and DNA integrity: a prospective trial.Int J Androl. 2011; 34: 14-19
- Does varicocele repair improve male infertility? An evidence-based perspective from a randomized, controlled trial.Eur Urol. 2011; 59: 455-461
- Effects of varicocele on testosterone, apoptosis and expression of StAR mRNA in rat Leydig cells.Asian J Androl. 2011; 13: 287-291
- Older age is associated with similar improvements in semen parameters and testosterone after subinguinal microsurgical varicocelectomy.J Urol. 2011; 185: 620-625
- The effect of microsurgical varicocelectomy on serum follicle stimulating hormone, testosterone and free testosterone levels in infertile men with varicocele.BJU Int. 1999; 84: 1046-1049
- Varicocele as a risk factor for androgen deficiency and effect of repair.BJU Int. 2011; 108: 1480-1484
- Does varicocelectomy improve gonadal function in men with hypogonadism and infertility? Analysis of a prospective study.Int J Endocrinol. 2011; 2011: 916380
- Improvement of sexual activity, pregnancy rate, and low plasma testosterone after bilateral varicocelectomy in impotence and male infertility patients.Arch Androl. 2003; 49: 219-228
- Impact of varicocelectomy on gonadal and erectile functions in men with hypogonadism and infertility.J Sex Med. 2011; 8: 885-893
- Hormonal parameters in incidental varicoceles and those causing infertility.Fertil Steril. 1986; 45: 692-700
- Relationship between varicocele size and response to varicocelectomy.J Urol. 1993; 149: 769-771
- Comparison of testicular volumes before and after varicocelectomy.Urol Int. 1998; 60: 220-223
- Relationship between grade of varicocele and the response to varicocelectomy.Int J Urol. 1996; 3: 282-285
- Preoperative parameters related to the improvement of semen characteristics after surgical repair of varicocele in subfertile men.Eur Urol. 1988; 14: 442-446
- Microsurgical inguinal varicocelectomy with delivery of the testis: an artery and lymphatic sparing technique.J Urol. 1992; 148: 1808-1811
- Varicocelectomy for infertile couples with advanced paternal age.Urology. 2008; 72: 109-113
- Effect of age and grade on surgery for patients with varicocele.Urology. 2005; 65: 768-772
Article info
Publication history
Published online: April 04, 2013
Accepted:
January 1,
2013
Received:
August 16,
2012
Footnotes
Financial Disclosure: Marc Goldstein is a consultant to Theralogix; the remaining authors declare that they have no relevant financial interests.
Identification
Copyright
© 2013 Published by Elsevier Inc.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial CommentUrologyVol. 81Issue 6
- PreviewAlthough an idiopathic age-related decline in testosterone has been well described, the etiology of low testosterone levels in the younger patient can be more elusive. Varicoceles are common in the general population but have been identified more frequently in infertile patients. Similarly, hypogonadism is more common in infertile men, and a shared etiology between hypogonadism and infertility might be the varicocele. Thus, the harmful effects of the varicocele, including testicular hyperthermia and the possible reflux of toxins, could affect not only spermatogenesis, but also Leydig cell function, and could negatively affect testosterone production.
- Full-Text
- Preview
- Re: Hsiao et al.: Varicocelectomy Is Associated With Increases in Serum Testosterone Independent of Clinical Grade (Urology 2013;81:1213-1218)UrologyVol. 82Issue 3
