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.
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.
Microsurgical varicocelectomy resulted in significant increases in the serum testosterone level, independent of the varicocele grade.
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Published online: April 04, 2013
Accepted: January 1, 2013
Received: August 16, 2012
Financial Disclosure: Marc Goldstein is a consultant to Theralogix; the remaining authors declare that they have no relevant financial interests.
© 2013 Published by Elsevier Inc.
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- 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.
- Re: Hsiao et al.: Varicocelectomy Is Associated With Increases in Serum Testosterone Independent of Clinical Grade (Urology 2013;81:1213-1218)UrologyVol. 82Issue 3