Effect of surgical repair on testosterone production in infertile men with varicocele: A meta‐analysis

Abstract

Abbreviations & AcronymsObjectives: To determine the effect of surgical varicocele repair in improving testicular Leydig cell function as shown by increased testosterone production. Methods: Eligible studies were searched in Medline and the Pubmed database, and cross-referenced as of 31 May 2011 using the terms "varicocele," "testosterone" and "surgery." The database search, quality assessment and data extraction were independently carried out by two reviewers. Only studies including patients with testosterone evaluation before and after surgery were considered for the analysis. A systematic review and meta-analysis was carried out for continues variables using random effect models. Results: Out of 125 studies, a total of nine were selected , including 814 patients. The combined analysis showed that mean serum testosterone levels after surgical treatment increased by 97.48 ng/dL (95% confidence interval 43.73-151.22, P = 0.0004) compared with preoperative levels. Conclusions: Surgical treatment of varicocele significantly increases testosterone production and improves testicular Leydig cell function.

Significant alterations of serum hormone levels in the spermatic vein plexus of patients with varicoceles

“…This phenomenon has been corroborated by another study (Page et al, 2006). A meta-analysis demonstrated that a microsurgical varicocelectomy or super-selective transvenous sclerotherapy facilitates the treatment of spermatic veins, prevents hydrostatic pressure, restores normal testosterone circulation and improves the peripheral testosterone level; therefore, surgical treatment of spermatic veins may significantly improve the peripheral testosterone level (Li et al, 2012). The level of peripheral testosterone was decreased in varicocele patients, and we deduced that this may have occurred because the gravity-associated higher hydrostatic pressure in the spermatic vein causes hormone circulation disorder in the early stages and testicular dysfunction over time, leading to lower testicular hormone levels.…”

Testosterone and Varicocele

“…Leydig cell dysfunction is now a recognized potential consequence of varicocele and appears to be a reversible phenomenon with varicocelectomy. 5 Multiple mechanisms for decreased androgen production have been proposed, likely reflecting a multifactorial process. Nevertheless, the pathophysiology of varicocelemediated Leydig cell dysfunction, as with the cause of the varicocele's link to subfertility, remains an area of ongoing research.…”

Laparoendoscopic Single-Site Surgery with a Single Channel Versus Conventional Laparoscopic Varicocele Ligation: A Prospective Randomized Study

“…2,3 Surgical repair of varicocele can improve testicular Leydig cell function, leading to remarkable catch-up growth, increased testosterone production, and improvement in fertility. [4][5][6] Recent studies and meta-analyses have shown that laparoscopic varicocelectomy is safe, effective, and costeffective with a low recurrence rate. [7][8][9][10] There is a trend toward minimizing the number of incisions and ports used in laparoscopic surgery, which has led to the description of laparoendoscopic single-site (LESS) surgery.…”