Impact of varicocelectomy on premature ejaculation in varicocele patients

Abstract

In a prospective manner, we studied the effect of varicocelectomy on premature ejaculation and testicular hormonal function in patients with varicocele. Microsurgical subinguinal varicocelectomy was carried out in 73 patients with clinical varicocele associated with premature ejaculation (group 1) and compared with 56 patients without operative intervention (group 2; control). The primary efficacy variable was the mean change in the Premature Ejaculation Diagnostic Tool. The changes in International Index of Erectile Function questionnaire, total serum testosterone and testicular size were also assessed. In group 1, the Premature Ejaculation Diagnostic Tool decreased significantly after varicocelectomy, from 15.56 to 11.37 (P < 0.001), indicating improvement of premature ejaculation. Thirty patients (41.1%) showed improvement of premature ejaculation compared to 5.3% in the control group (P < 0.001). In group I, but not in group II, testosterone levels and International Index of Erectile Function values increased significantly when compared with pre-operative values (P< 0.001 and 0.040 respectively). Testicular size increased after varicocelectomy, but this increase was nonsignificant till the end of study (P = 0.054). We concluded that varicocelectomy is clearly related to improvement of premature ejaculation and testicular hormonal function in varicocele patients.

The pathophysiology of acquired premature ejaculation

“…The authors also note that venous congestion through a connection between the testicular and prostatic venous systems may predispose a varicocele patient to prostatitis. Consistent with these findings, there have been preliminary reports from methodologically flawed studies of improvements in men with PE treated with varicoelectomy (138,139). …”

Testosterone and Varicocele

“…Even when viewed from this lens, one cannot ignore the number of well-fashioned studies that include relatively large numbers of subjects. 24,26,[28][29][30][31] Although a great deal of work has thus established the link between varicocele and decreased androgen production, the pathophysiologic principles that result in this association have yet to be identified.…”

Effects of varicocelectomy on serum testosterone

“…These results mirror prior literature demonstrating improved SA results in men with abnormal SA and varicocele, which suggests that varicocele, Sertoli cell and Leydig cell dysfunction may be intertwined. In addition to the above data, Ahmed et al demonstrated improvement in TT in 81.8% of men with low TT compared to only 17.5% with normal TT (42). Interestingly, Zhody et al (38) and Srini et al (39) also noted that men who did not undergo repair had decreased TT.…”

“…This was most prominently observed in hypogonadal men or men with low-normal TT. Of the fifteen studies with increased TT, twelve (22,26,27,30,38-43,49,50) were with average initial TT <400 ng/dL with six of seven prospective studies in hypogonadal or low-normal TT levels (27,38,39,41,42,49). When weighted according to patient population, the average starting TT for those with increased TT was 326 ng/dL while the average TT for those without increased TT was 535 ng/dL.…”

“…Nor were there any differences in changes in TT amongst the age groups. Hsiao et al reviewed 114 men with infertility or hypogonadism undergoing subinguinal microsurgical varicocele repair (42). Men were grouped as <30, 31–39 and >39 years of age.…”