There are three major types of varicocele complications men may experience. be the cause of infertility in their relationship, the news may often lead to: Sexual dysfunction, or inability to get an erection; Low libido, or sex. This investigation succeeded in identifying an association between both varicocele and ED. We also realized that varicocele patients who underwent a. Keywords: erectile dysfunction; hypogonadism; varicocele; varicocelectomy . A significant positive correlation between the improvement of the.
However, in the control group, there was an increase from 39 to 41 in the participants who suffered ED during the follow-up period. This was an incidental isolated finding of this study. Discussion The serum testosterone level showed significant increase after varicocelectomy unlike the changes in the control group in our study.
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This is in agreement with the previous work of other authors [ 8 — 10 ]. The increase in serum TT was greater in cases of bilateral varicocelectomy as compared with unilateral cases [ 8 ]. In our study, we failed to demonstrate such differences.
Hurtado de Catalfo et al. The clinical grade and the vein diameter might not be the determining factors for how varicocele affects testicular functions. Serum testosterone increased after varicocelectomy in the study group. However, the magnitude of this increase was not the same in all participants. The same observation had been documented by other investigators [ 1112 ]. These findings suggest that improved spermatogenesis might have a mechanism other than increased testosterone production.
Moreover, classification of men based on their preoperative TT may explain variation in TT improvement between different studies. Many studies that failed to demonstrate the positive change in the serum testosterone level following varicocelectomy did not characterize patients with low preoperative serum testosterone.
Our results are in agreement with Su et al. This suggests that varicocelectomy can reverse the Leydig cell dysfunction induced by varicocele in certain patients.
International Journal of Endocrinology
This is confirmed by Ghosh and York in their study [ 26 ]. The mechanism by which testosterone synthesis is affected is not yet clear. Possible mechanisms include reduced activity of 17,desmolase and alpha-hydroxylase enzymes as a result of testicular hyperthermia [ 27 ] and impaired Leydig cell response to gonadotrophin stimulation [ 2829 ]. In this current study, serum LH and serum FSH decreased insignificantly following varicocelectomy in the hypogonadal patients study groupwhile there was no significant change in the control group; this might be attributed to improvement in Leydig cell function, which was increased due to raise in serum TT in the study group.
Previous researchers reported no effect of varicocelectomy on serum LH, even when mean serum TT levels improved [ 8 ]. This might be due to the fact that eugonadal and hypogonadal patients were mixed together in the patient population.
It was also noticed that the study group in whom varicocelectomy was done noticed improved erectile function postoperatively.
This might be related to improvement in the TT level which plays an important role in the male sexual response and regulates the timing of the erectile process as a function of sexual desire, thereby coordinating penile erection with sex [ 30 ]. This correlation was not found in the control group: In our study we noted a significant normalization of TT values due to the marginal lower TT levels before varicocelectomy as compared to other studies which shows the importance of early diagnosis and surgical treatment.
Few previous researchers have reported the relationship between varicocele and hypogonadism [ 3132 ]. Younes [ 31 ] reported on 48 impotent men who underwent bilateral varicocelectomy. He reported that the serum testosterone level was significantly increased in impotence and male infertility compared to levels achieved in fertile groups.
Lotti and coworkers [ 33 ] elegantly analyzed the impact of varicocele on sexual function in a large series of subjects. It is important to note the negative impact of infertility on sexual desire [ 34 — 38 ]. There are no generally accepted lower limits of normal. Clinician should be aware of the risk factors for hypogonadism, which include chronic illnesses including diabetes mellitus, inflammatory arthritic, renal, and HIVobesity, and metabolic syndrome.
Such chronic diseases should be investigated and treated. When pituitary etiology is suspected, measurements of serum LH will differentiate between primary and secondary hypogonadism, and serum prolactin is indicated when the serum testosterone is extremely low. Testicular biopsies before and 1 year after the varicocele repair showed significant improvements in the appearance of seminiferous tubules after surgery. Impairments in testicular function resulting from varicocele are thought to be related to increased testicular temperature, leading to detrimental effects on spermatogenesis, impaired Sertoli cell function, abnormal testicular-protein metabolism, and decreased testicular Leydig cell production of testosterone.
Varicocele is associated with erectile dysfunction: a population-based case-control study.
This could explain some of the repercussions on both sperm and testis function, including testosterone production. Sertoli cell dysfunction can be detected by the decrease in the responsiveness to follicle stimulating hormone FSHand by alterations in androgen binding protein ABP and inhibin-B.
Men with varicocele were observed to have Leydig cell structural changes, Leydig cell atrophy, and notable decreases in the quantity of testosterone positive Leydig cells. The increase in the testicular temperature could have a negative effect on the enzyme's action, thus resulting in decreased testosterone production. Retrospective review of the effect of varicocelectomy on testosterone levels in infertile men with varicoceles showed a significant increase in serum levels after repair.
Men with at least 1 firm testis preoperatively had the greatest increase in serum testosterone postrepair. Therefore, early varicocelectomy is advocated to prevent progressive loss of testicular volume. It is also well-documented that the prevalence of hypogonadism increases with age. In older men who develop a varicocele and hypogonadism, the benefit of varicocelectomy on serum testosterone levels is related to patient age.
Men in the fifth and sixth decades of life who underwent varicocelectomy for low serum total testosterone improved as much as younger men.
However, the changes in serum inhibin B concentration after varicocelectomy might be helpful in evaluating improvement in seminiferous tubules function before and after varicocelectomy.
Swelling of Scrotal Veins Related to ED | The Medicine Shoppe
Moreover, classification of men based on their preoperative total testosterone may explain variation in the testosterone levels improvement between different studies. Many studies that failed to demonstrate the positive change in the serum testosterone level following varicocelectomy did not characterize patients with low preoperative serum testosterone. A study compared men with varicocele and infertility who underwent repair to infertile men with varicocele without treatment, men with varicocele but were fertile, and normal men no varicocele no infertility.
At a 6-month follow-up, testosterone levels were improved significantly after varicocele repair compared with no repair. The postvaricocelectomy men demonstrated levels comparable to those of fertile men with varicocele.How To Get Rid Of A Varicocele (Varicose Veins) Naturally
The latter finding raises a question as to whether improved serum testosterone is related to improved fertility potential. However, the improved postvaricocelectomy testosterone levels did not achieve levels comparable with those of normal fertile men without varicoceles,  suggesting that some of the testicular damage and decrease in the function might not be reversible and early detection and repair might be important in these patients. Men with varicocele and hypogonadism should be offered surgical repair, even when future fertility is not an issue, such as men seen for vasectomy.
The risks associated with testosterone replacement therapy should be discussed. Men with varicocele should also be counseled after surgical repair that they might still require testosterone supplementation to help alleviated symptoms of testosterone deficiency.
Varicocele And Erectile Function Very few studies have evaluated the association of varicocele and erectile dysfunction ED.
In a study that performed a population-based analysis to evaluate these associations after stratifying by age, the youngest men with ED were found to have the strongest magnitudes of association with varicocele OR: