Effect of microsurgical varicocele repair on sexual functions and testosterone in hypogonadal infertile men with varicocele

Abstract

Objective: To investigate effect of microsurgical varicocele repair on sexual functions and serum total testosterone level in infertile hypogonadal men with varicocele, and also to determine factors that might predict improvement in total testosterone level after surgery. Methods: The study included 202 infertile hypogonadal men (total testosterone level of <3.5 ng/mL) with varicocele who underwent microsurgical sub-inguinal varicocele repair. Results: Mean serum total testosterone level significantly increased from 2.55 ± 0.66 ng/mL to 3.72 ± 1.34 ng/mL after varicocelectomy (p ¼ .000), and 105 patients (52%) had serum total testosterone level of !3.5 ng/mL after the surgery. Mean international index of erectile functions (IIEF-EF) score significantly increased from 27.47 ± 2.96 to 28.61 ± 2.02, post-operatively (p ¼ .000). Of the patients who had pre-operative IIEF-EF score of 26, 65.5% had IIEF-EF score of !26 after varicocelectomy. Of the patients who had pre-operative decreased libido, 86.6% had postoperative increased libido. Only older patient age was the predictor for having total testosterone level of !3.5 ng/mL after the surgery (p ¼ .031). Conclusions: Data suggest that serum total testosterone level, IIEF-EF score and sexual libido significantly increase after varicocele surgery. As the age increases, total testosterone level increased after varicocele surgery. Therefore, varicocele repair could be offered to hypogonadal men with clinically varicocele.

Can we recommend varicocele surgery for men with hypogonadism?

“…Mean serum TT levels increased from 255 ± 66 ng/dL to 372 ± 134 ng/dL (p = 0.000), while serum FSH (p=0.198), LH (p=0.207) and prolactin (p=0.345) levels did not significantly change from pre to post-operative period. Also, IIEF-EF score significantly increased from 27.47 ± 2.96 (15–30) to 28.61 ± 2.02 (18–30), after surgery (p=0.000) ( 31 ).…”

“…Also, some trials demonstrated the improvement in seminal parameters such as motility, sperm concentration and Total Motile Sperm Count (TMSC) ( 20 , 31 ) after correction of varicocele. The benefit related to improvement of FSH and LH levels remains uncertain ( 18 , 19 , 21 , 31 ).…”

Relationship between Varicocele and Male Hypogonadism: A Review with Meta-Analysis

“…On the other side, recent trials support the correlation between varicocelectomy and improved seminal parameters [25]. Since appropriate intratesticular testosterone levels are necessary to guarantee spermatogenesis, the investigation of Lyedig cell function is fundamental to the evaluation of infertile patients [29].…”

“…Finally, Saylam et al demonstrated that mean serum total testosterone level significantly increased from 2.55 to 3.72 after varicocelectomy (p < 0.0001), and 105 patients (52%) had a serum total testosterone level of ≥ 3.5 ng/mL after the surgery [25].…”

“…Testosterone levels pre-and after surgery were reported in four studies [20][21][22]25]. There was statistically significant heterogeneity in these studies (x 2 = 267.09, I 2 = 72%; p = 0.01) (Figure 1).…”