Male Sexual Dysfunction| Volume 110, P104-109, December 2017

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Improvements in Patient-reported Sexual Function After Microsurgical Varicocelectomy

  • Author Footnotes
    1 Contributed equally to the study.
    Bobby B. Najari
    1 Contributed equally to the study.
    Departments of Urology and Population Health, New York University School of Medicine, New York, NY
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  • Author Footnotes
    1 Contributed equally to the study.
    Leonard Introna
    1 Contributed equally to the study.
    Department of Urology, Weill Cornell Medical College, New York, NY
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  • Darius A. Paduch
    Address correspondence to: Darius A. Paduch, M.D., Ph.D., Department of Urology, Weill Cornell Medical College, 525 East 68th St, Starr 900, New York, NY 10065.
    Department of Urology, Weill Cornell Medical College, New York, NY

    Department of Reproductive Medicine, Weill Cornell Medical College, New York, NY
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  • Author Footnotes
    1 Contributed equally to the study.


      To evaluate whether varicocelectomy improves both serum testosterone and sexual function, as assessed by the Male Sexual Health Questionnaire (MSHQ).


      A retrospective chart review of patients who have undergone varicocelectomy and had both pre- and postoperative MSHQ was performed. The MSHQ is a clinically validated questionnaire that assesses erectile function, ejaculatory function, and sexual satisfaction, with higher scores indicating better function. Clinical parameters pre and postvaricocelectomy were compared with paired t test.


      Thirty-four patients met study criteria. Seventeen patients (50%) presented for infertility, and the remaining 13 had symptomatic varicocele associated with hypogonadism. Average postsurgical follow-up was 20.6 ± 12.5 months. The majority of men in the study had bilateral varicoceles and left grade III varicoceles. Significant improvements in the total MSHQ score (3.9 ± 8.7, P = .027), the MSHQ erectile function (1.2 ± 2.3, P = .007), and the MSHQ ejaculatory function (1.4 ± 3.1, P = .018) domains were seen. Fifteen (44%) men saw improvement in their erectile function and 18 (53%) saw improvement in ejaculatory function. The improvement in serum testosterone was also significant (136.0 ± 201.3 ng/dL, P = .007).


      Microsurgical repair of varicocele not only improves testosterone, but also improves patient-reported erectile and ejaculatory functions. Patients can confidently be counseled that varicocelectomy has the potential to improve sexual function along with serum testosterone.
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      • Re: Najari et al: Improvements in Patient-reported Sexual Function After Microsurgical Varicocelectomy (Urology 2017;110:104-109)
        UrologyVol. 115
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          I read the article by Najari et al,1 which demonstrated the improvements in testosterone level and patient-reported sexual function after microsurgical repair of varicocelectomy with great interest. Najari et al used the Male Sexual Health Questionnaire (MSHQ) to assess the pre- and postoperative sexual functioning along with serum testosterone and luteinizing hormone levels. However, I want to highlight some issues related to this article. First of all, the patient cohort is heterogeneous such that 50% of them presented with infertility and the remaining 50% presented with sexual dysfunction, including erectile dysfunction and diminished libido.
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