Treatment Outcomes of Microsurgical Inguinal Varicocelectomy Versus Testosterone Replacement Therapy in Male Hypogonadism by Varicocele Status

IF 1.3 4区医学 Q3 ANDROLOGY

Andrologia Pub Date : 2026-09-17 DOI:10.1155/and/8818332

Hieu Trung Nguyen, Ai Le Kha Nguyen, Cuong Quoc Tran, Cuong Van Dam, Tin Hoang Nguyen, Kien Trung Nguyen

{"title":"Treatment Outcomes of Microsurgical Inguinal Varicocelectomy Versus Testosterone Replacement Therapy in Male Hypogonadism by Varicocele Status","authors":"Hieu Trung Nguyen, Ai Le Kha Nguyen, Cuong Quoc Tran, Cuong Van Dam, Tin Hoang Nguyen, Kien Trung Nguyen","doi":"10.1155/and/8818332","DOIUrl":null,"url":null,"abstract":"<div>\n \n <section>\n \n <h3> Objective</h3>\n \n <p>To compare the short-term effects of microsurgical inguinal varicocelectomy (MIV) and testosterone replacement therapy (TRT) on symptoms, serum testosterone, and semen quality in men with late-onset hypogonadism (LOH) according to varicocele status.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>A 3-month prospective, non-randomized, interventional cohort study was conducted in symptomatic men with testosterone deficiency and/or abnormal semen parameters. 120 patients underwent clinical, laboratory, and scrotal Doppler ultrasonographic assessment. Accordingly, 39 patients with varicocele chose MIV, 35 with varicocele chose TRT with Androgel (5 g/day), and 46 without varicocele were treated with Androgel (5 g/day). Questionnaires (ANDROTEST, ADAM, AMS, and IIEF), serum total testosterone levels, and semen analysis according to WHO 2021 criteria were assessed before and after treatment.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Ejaculatory abstinence duration demonstrated the strongest correlations with semen quality (<i>ρ</i> up to 0.52), whereas serum reproductive hormones showed only weak associations. TRT in patients without varicocele achieved the greatest improvement in the ANDROTEST and ADAM symptom domains. All treatment strategies significantly increased serum testosterone levels (all adjusted <i>p</i> < 0.001). ANCOVA models showed that MIV was not associated with a higher adjusted IIEF erectile function domain score and resulted in lower adjusted serum testosterone than TRT, although the adjusted total IIEF score was higher. In contrast, MIV consistently improved semen volume, sperm concentration, total sperm count, progressive motility, total motility, vitality, and normal morphology, whereas TRT led to deterioration in several semen parameters (adjusted <i>p</i> < 0.05).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Short-term treatment strategies for LOH produced distinct clinical benefits. TRT provided more rapid symptom relief and effectively increased serum testosterone, whereas MIV was associated with more favorable recovery of spermatogenic parameters among patients with varicocele. Hence, MIV may be considered a fertility-preserving first-line option in patients with clinical varicocele who wish to preserve fertility.</p>\n </section>\n </div>","PeriodicalId":7817,"journal":{"name":"Andrologia","volume":"2026 1","pages":""},"PeriodicalIF":1.3000,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/and/8818332","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Andrologia","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1155/and/8818332","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ANDROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

To compare the short-term effects of microsurgical inguinal varicocelectomy (MIV) and testosterone replacement therapy (TRT) on symptoms, serum testosterone, and semen quality in men with late-onset hypogonadism (LOH) according to varicocele status.

Methods

A 3-month prospective, non-randomized, interventional cohort study was conducted in symptomatic men with testosterone deficiency and/or abnormal semen parameters. 120 patients underwent clinical, laboratory, and scrotal Doppler ultrasonographic assessment. Accordingly, 39 patients with varicocele chose MIV, 35 with varicocele chose TRT with Androgel (5 g/day), and 46 without varicocele were treated with Androgel (5 g/day). Questionnaires (ANDROTEST, ADAM, AMS, and IIEF), serum total testosterone levels, and semen analysis according to WHO 2021 criteria were assessed before and after treatment.

Results

Ejaculatory abstinence duration demonstrated the strongest correlations with semen quality (ρ up to 0.52), whereas serum reproductive hormones showed only weak associations. TRT in patients without varicocele achieved the greatest improvement in the ANDROTEST and ADAM symptom domains. All treatment strategies significantly increased serum testosterone levels (all adjusted p < 0.001). ANCOVA models showed that MIV was not associated with a higher adjusted IIEF erectile function domain score and resulted in lower adjusted serum testosterone than TRT, although the adjusted total IIEF score was higher. In contrast, MIV consistently improved semen volume, sperm concentration, total sperm count, progressive motility, total motility, vitality, and normal morphology, whereas TRT led to deterioration in several semen parameters (adjusted p < 0.05).

Conclusion

Short-term treatment strategies for LOH produced distinct clinical benefits. TRT provided more rapid symptom relief and effectively increased serum testosterone, whereas MIV was associated with more favorable recovery of spermatogenic parameters among patients with varicocele. Hence, MIV may be considered a fertility-preserving first-line option in patients with clinical varicocele who wish to preserve fertility.

查看原文本刊更多论文

显微外科腹股沟精索静脉曲张切除术与睾酮替代疗法治疗精索静脉曲张状态男性性腺功能低下的疗效

目的比较显微外科腹股沟精索静脉曲张切除术（MIV）与睾酮替代疗法（TRT）对迟发性性腺功能减退症（LOH）男性症状、血清睾酮和精液质量的近期影响。方法对睾酮缺乏和/或精液参数异常的有症状男性进行为期3个月的前瞻性、非随机、干预性队列研究。120例患者接受了临床、实验室和阴囊多普勒超声检查。据此，39例精索静脉曲张患者选择MIV， 35例精索静脉曲张患者选择TRT联合Androgel (5 g/d)， 46例无精索静脉曲张患者选择Androgel （5 g/d）。根据WHO 2021标准评估治疗前后的问卷调查（ANDROTEST、ADAM、AMS和IIEF）、血清总睾酮水平和精液分析。结果禁欲时间与精液质量的相关性最强（ρ为0.52），而血清生殖激素与精液质量的相关性较弱。在没有精索静脉曲张的患者中，TRT在ANDROTEST和ADAM症状领域取得了最大的改善。所有治疗策略均显著提高血清睾酮水平（均校正p <； 0.001）。ANCOVA模型显示，与TRT相比，MIV与更高的调整后的IIEF勃起功能域评分无关，并导致调整后的血清睾酮低于TRT，尽管调整后的IIEF总分更高。相比之下，MIV持续改善精液体积、精子浓度、精子总数、进行性运动性、总运动性、活力和正常形态，而TRT导致精液多项参数恶化（调整p <； 0.05）。结论LOH的短期治疗策略具有明显的临床疗效。TRT能更迅速地缓解症状并有效地增加血清睾酮，而MIV与精索静脉曲张患者的生精参数恢复更有利相关。因此，对于希望保留生育能力的临床精索静脉曲张患者，MIV可能被认为是保留生育能力的一线选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Andrologia 医学-男科学

CiteScore

5.60

自引率

8.30%

发文量

292

审稿时长

6 months

期刊介绍： Andrologia provides an international forum for original papers on the current clinical, morphological, biochemical, and experimental status of organic male infertility and sexual disorders in men. The articles inform on the whole process of advances in andrology (including the aging male), from fundamental research to therapeutic developments worldwide. First published in 1969 and the first international journal of andrology, it is a well established journal in this expanding area of reproductive medicine.