Varicocele

Discussion in 'Men's Health Forum' started by Michael Scally MD, Oct 3, 2012.

  1. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Fisch H, Hyun G. Varicocele repair for low testosterone. Current Opinion in Urology;Publish Ahead of Print. Varicocele repair for low testosterone : Current Opinion in Urology

    Purpose of review: Several recent clinical studies have added to the existing literature on the impact of varicocelectomy on serum testosterone levels. These studies were not included in the most recent previous review of this topic and strengthen considerably the evidence base supporting the claim that varicocele repair can reliably restore below-normal testosterone levels.

    Recent findings: Three studies were published in 2011 on the effect of varicocele repair on testosterone levels. These studies were all adequately powered to detect statistically significant changes in testosterone preprocedure and postprocedure, and all demonstrated significant increases in testosterone levels in patients who had low preprocedure testosterone levels.

    Summary: Varicocele repair can restore testosterone to the eugonadal range in hypogonadal patients with either unilateral or bilateral varicocele.
     
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  2. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    We investigated the possible relationship between body mass index (BMI) score and varicocele recurrence in an infertile patient population. A total of 255 primary infertile male patients (138 with varicocele and 117 for control) were included in this study. Height and weight measurements, clinical examination for varicocele, determination of serum hormone levels and spermiogram were performed in all cases. The BMI score was calculated, and patients with varicocele were operated with subinguinal technique and re-examined for recurrences.

    The varicocele group had significantly lower weight and the BMI score than the control group (P < 0.001). Varicocele recurrences were found in 22 patients (16% of them) after the operations. The BMI score was significantly lower in the recurrent group than in the nonrecurrent and control groups (P < 0.001).

    73% of the recurrent, 50% of the nonrecurrent and 25% of the control group patients' BMI scores were under 25 kg m(-2) (P < 0.001). In logistic regression analysis, the BMI score was found as a determinant for varicocele recurrence (P = 0.027; OR: 1.25).

    It is concluded that BMI score lower than 25 kg m(-2) significantly increases the recurrence rate after varicocele operation, and it can be used as an objective indicator for microsurgical varicocelectomy.

    Gorur S, Candan Y, Helli A, et al. Low body mass index might be a predisposing factor for varicocele recurrence: a prospective study. Andrologia 2015;47(4):448-54. Low body mass index might be a predisposing factor for varicocele recurrence: a prospective study - Gorur - 2014 - Andrologia - Wiley Online Library
     
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  3. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    [Open Access] When is a varicocele repair indicated: the dilemma of hypogonadism and erectile dysfunction?

    In the past, the indications for varicocelectomy are primarily for infertility with abnormal semen parameters, testicular hypotrophy/atrophy in adolescents, and/or pain.

    The surgical treatment of varicocele for hypogonadism is controversial and debated. Recently, multiple reports in the literature have suggested that varicocele is associated with hypogonadism and varicocele repair can increase testosterone levels.

    Men with hypogonadal symptoms should have at least two serum testosterone levels. Microsurgical varicocelectomy may be beneficial for men with clinically palpable varicoceles with documented hypogonadism.

    In this review, we summarize the most recent literature linking varicocele to hypogonadism and sexual dysfunction and the impact of repair on serum testosterone levels. We performed a search of the published English literature.

    The key words used were "varicocele and hypogonadism" and "varicocele surgery and testosterone." We included published studies after 1998. We, also, evaluated the effect of surgery on the changes in the serum testosterone level regardless of the indication for the varicocele repair.

    Dabaja AA, Goldstein M. When is a varicocele repair indicated: the dilemma of hypogonadism and erectile dysfunction? Asian J Androl. When is a varicocele repair indicated: the dilemma of hypogonadism and erectile dysfunction? Dabaja AA, Goldstein M, - Asian J Androl
     
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  4. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Vakalopoulos I, Kampantais S, Lymperi S, et al. Should we expand the indications for varicocele treatment? Transl Androl Urol 2017;6:931-42. Should we expand the indications for varicocele treatment? - Vakalopoulos - Translational Andrology and Urology

    Current guidelines suggest that treatment of varicocele should be considered in patients with clinically palpable disease and abnormal semen parameters. However, the clinicians are often challenged with the decision whether to treat varicocele in patients with testicular pain or low testosterone levels. Moreover, varicocele is highly associated with DNA fragmentation due to the oxidative stress and it has been demonstrated that surgical repair of varicocele ameliorates oxidative stress markers and consequently the sperm DNA integrity. These new markers could have an adjunctive role to standard semen parameters especially when normal semen analysis is found in adult men with conventional methods.

    This review presents a contemporary overview of the rationale for varicocele treatment, as well as of the relationship between varicocele and other novel parameters such as DNA fragmentation index and reactive oxygen species. We will also discuss data from several recent series demonstrating that surgical treatment and especially microsurgical approach could resolve testicular pain, increase testosterone levels and fertility rate both in patients with non-obstructive azoospermia as well as in normozoospermia men. The correlation with progressive testicular failure will be also examined. We hope that this overview will provide clinicians with an evidence-based approach to managing these unanswered and conflicting topics.
     
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  5. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Wang NN, Dallas K, Li S, Baker L, Eisenberg ML. The association between varicocoeles and vascular disease: an analysis of U.S. claims data. Andrology. The association between varicocoeles and vascular disease: an analysis of U.S. claims data

    S‪tudies have suggested an association between varicocele, hypogonadism, and elevated oxidative stress markers, but no other health risks have been associated with varicoceles.

    We sought to determine the association between varicocele and incident medical comorbidities. Using the Truven Health MarketScan® claims database from 2001 to 2009, we identified 4459 men with varicoceles, and 100,066 controls based on ICD-9 and CPT codes, with an average follow-up of 3.1 person years.

    Men with varicoceles were classified as symptomatic or asymptomatic based on co-existing diagnoses. Men with medical comorbidities present before or within 1 year of index diagnosis were excluded. Metabolic and cardiovascular outcome variables were identified via ICD-9 codes. A Cox regression analysis was used to assess incident risk of metabolic and cardiovascular disease amongst the different groups.

    Men with varicoceles had a higher incidence of heart disease compared to men who underwent infertility testing (HR 1.22, 95% CI: 1.03–1.45), and men who underwent vasectomy (HR 1.32, 95% CI 1.13–1.54). The varicoceles group also had a higher risk of diabetes (HR 1.73, 95% CI: 1.37–2.18) and hyperlipidemia (HR 1.15, 95% CI: 1.03–1.28) compared to the vasectomy group.

    Furthermore, men with symptomatic varicoceles (n = 3442) had a higher risk of heart disease, diabetes, and hyperlipidemia following diagnosis, while men with asymptomatic varicoceles (n = 1017) did not.

    Given the prevalence of varicoceles, further research is needed to understand the implications of a varicocele to a man's overall health.
     
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  6. Theworm

    Theworm Member

    I had a vericocelectomy back in 2010. Pre surgery TT was 388. Never checked it after adequately (always checked after cycles and it was low). Long story short, I'm on trt for 2 years now (39 years old). Wonder if it be worth a restart to see where I am? @Michael Scally MD ?
     
  7. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    [OA] The Varicocele Argument Resurfaces

    A recent series of articles and reviews published in Fertility and Sterility have rekindled the more than half century debate on varicocelectomy. Every one of these articles favored strongly the repair of varicocele for male infertility.

    Since my review paper on this issue in 2001, published in Human Reproduction Update, and since advent of ICSI in 1993, I had thought that most reproductive physicians felt negatively about the benefit of varicocelectomy.

    However, more recent urological papers are causing this negative view to be re-evaluated. It is now advocated by some urologists that varicocelectomy improves sperm count and testosterone levels, and even improves the results with ICSI.

    Thus, it may be appropriate to revisit older studies again and review the newer ones in this never ending controversy. Newer studies are re-opening the door to review and possibly re-instate varicocelectomy. This dilemma may never be fully resolved, but it is important to keep an open mind.

    Silber S. The varicocele argument resurfaces. Journal of assisted reproduction and genetics 2018. https://link.springer.com/article/10.1007%2Fs10815-018-1160-2
     
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  8. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    The Prevalence and Severity of Varicocele in Adult Population Over the Age Of Forty Years Old

    OBJECTIVES: To investigate the prevalence and severity of varicocele in adult population over the age of 40. We also measured testicular size, consistency, and total testosterone levels with an aim to observe the effect of varicocele on testis as men age.

    METHODS: Two hundred twenty-four patients with varicocele, 241 patients without varicocele who admitted to our clinic were enrolled in the study. We stratified participants by four age groups (40-49, 50-59, 60-69, >70 yr). Patients were grouped according to varicocele grade and laterality. The morning testosterone level was drawn. The subgroups were compared with each other.

    RESULTS: Overall, varicocele prevalence was 48%. Of the patients, 104 had unilateral, 120 had bilateral varicocele. Of the patients with varicocele, 62 (13.30%) were found as grade 3, 99 (21.10%) were grade 2, and 63 (13.60%) were grade 1.

    The percentages of smaller testes in grade 1, grade 2, and grade 3 varicocele group were 20.60, 79.80, and 88.70 and a significant association was detected. Age stratification of the data revealed the smaller and soft testis prevalence as well as higher grade varicocele prevalance increased in older age groups.

    CONCLUSIONS: Varicocele presence is associated with lower testicular size, softer testicular consistency, and lower testosterone levels, especially in older patients with bilateral and high-grade varicocele.

    Besiroglu H, Otunctemur A, Dursun M, Ozbek E. The prevalence and severity of varicocele in adult population over the age of forty years old: a cross-sectional study. The aging male: the official journal of the International Society for the Study of the Aging Male 2018:1-7. https://www.tandfonline.com/doi/abs/10.1080/13685538.2018.1465913?journalCode=itam20