Elsevier

Urology

Volume 81, Issue 6, June 2013, Pages 1213-1218
Urology

Infertility
Varicocelectomy Is Associated With Increases in Serum Testosterone Independent of Clinical Grade

https://doi.org/10.1016/j.urology.2013.01.060Get rights and content

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.

Section snippets

Patients and Evaluation

After obtaining institutional review board approval, we performed a retrospective review of patients who had undergone subinguinal microsurgical varicocelectomy by a single surgeon from January 1996 to January 2010. Patients were referred for male infertility, testicular pain, and/or low testosterone. In our practice, the indications for varicocelectomy include clinically palpable varicocele with semen parameter abnormalities, clinically palpable varicocele associated with pain, clinically

Baseline Characteristics

A total of 78 men were included in the final analysis. Their average age was 36.4 ± 1.0 years. Of these 78 men, 59 had undergone bilateral varicocelectomy and 19 unilateral varicocelectomy. When divided by bilateral versus unilateral varicocelectomy, no differences were found in the endocrine parameters or sperm counts (Table 1). We classified the 59 patients who had undergone bilateral varicocelectomy by the largest varicocele present on either side: 35 (59%) had a grade 3 varicocele, 17 (29%)

Comment

In the present study, varicocelectomy was associated with improvement in the serum testosterone level in >80% of patients, with a mean increase of approximately 140 ng/dL in those with improvement. Although the correction of a greater clinical grade of varicoceles has been shown to result in greater improvement in semen parameters, the clinical grade does not seem to predict improvement in the serum testosterone level.

It is notable that our practice has not offered varicocelectomy to those

Conclusion

The results of our study have shown that subinguinal microsurgical varicocelectomy is associated with significant increases in serum testosterone levels, regardless of the palpable varicocele grade. Our results suggest that repair of even small varicoceles can increase serum testosterone levels. We have demonstrated an improvement in serum testosterone levels in a younger population; however, additional studies are needed of older men with symptomatic low testosterone levels.

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Financial Disclosure: Marc Goldstein is a consultant to Theralogix; the remaining authors declare that they have no relevant financial interests.

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