Whelan Patrick, Levine Laurence
Department of Urology, Rush University Medical Center, Chicago, IL 60612, USA.
Transl Androl Urol. 2016 Dec;5(6):866-876. doi: 10.21037/tau.2016.08.06.
Varicocele is most often surgically repaired due to male infertility, however, has recently been linked to low serum testosterone. This paper serves to review the current literature regarding varicocele and its subsequent repair on serum testosterone. Twenty-eight human studies were identified with fifteen showing improved serum testosterone after repair. The majority of the studies that demonstrated improvement had preoperative testosterone levels that were low or below normal. Additionally, multiple well-designed studies with control groups not undergoing surgical repair demonstrated significant difference between groups. This improvement was less observed in studies with normal preoperative serum testosterone. A majority of these patients studied were presenting for infertility. It remains to be determined if these findings can be reproduced in men without infertility. The findings suggest that microsurgical varicocele repair can improve serum testosterone in men with low levels preoperatively in appropriately counseled men. It remains to be seen whether varicocele repair can help prevent the development of low testosterone in the future or which patients are at risk of developing low testosterone due to varicocele.
精索静脉曲张通常因男性不育而进行手术修复，然而，最近它与血清睾酮水平低有关。本文旨在综述目前关于精索静脉曲张及其修复对血清睾酮影响的文献。共确定了28项人体研究，其中15项显示修复后血清睾酮水平有所改善。大多数显示有改善的研究中，患者术前睾酮水平较低或低于正常水平。此外，多项设计良好的有未接受手术修复对照组的研究表明，两组之间存在显著差异。在术前血清睾酮正常的研究中，这种改善较少被观察到。这些研究中的大多数患者是因不育前来就诊。对于没有不育问题的男性，这些发现是否能重现仍有待确定。研究结果表明，对于术前睾酮水平低且接受了适当咨询的男性，显微外科精索静脉曲张修复术可改善血清睾酮水平。精索静脉曲张修复术能否有助于预防未来低睾酮的发生，或者哪些患者有因精索静脉曲张而发生低睾酮的风险，仍有待观察。
