Effect of Varicocelectomy on Gonadal Function among Patients Reporting with Sexual Dysfunction in Ghana

Abstract

Background: Long-standing varicocele is often associated with testicular hypoxia and that might worsen Leydig cell function, a significant risk factor for hypogonadism. This may affect both the secretory and endocrine functions of the testis. This study aims to determine the effect of microsurgical sub-inguinal varicocelectomy on gonadal function among men reporting sexual dysfunction in Ghana. Methods: This was an intervention study conducted at the Tamale Teaching Hospital from September 2017 to August 2021. A total of 103 participants were randomized into two groups; the surgery group (n = 52) and the observed group (n = 51). Venous blood samples were collected at baseline, varicocelectomy was performed for the surgery group, and no intervention was given to the other. Blood samples were subsequently collected at 12-, 24-, 36-, and 48-month intervals for assay of serum total testosterone, FSH, and LH. The data were analyzed in GraphPad Prism (v8.0) at an alpha value of 0.05. Results: All the participants had varicocele and were aged between 55.0 to 69.0 years old. At the baseline of the study, all participants presented with sexual dysfunction but a significant improvement (p < 0.001) in the GRISS score, and the subscale was observed 12 months after the surgery. The mean ± SD serum total testosterone (p = 0.6078), FSH (p = 0.6522) and LH (p = 0.2281) between the groups at baseline did not vary but those in surgery group had improved values at 12-, 24-, 36- and 48-month post-surgery (p-trend < 0.0001). The surgery group had an overall percent increase in serum total testosterone (76.3%, 194.0%, 221.0%, and 231.9%) over 12-, 24-, 36- and 48-month and significant percent reduction in both FSH (-14.7%, -29.9%, -33.8% and -40.8%) and LH (-21.8%, -31.0%, -32.4%, and -36.4%) respectively. These gonadotropins observed annual percentages spike within the first and second year but changes were marginal from the third year onwards in the surgery group. Conclusions: Microsurgical sub-inguinal varicocelectomy improved gonadal function among varicocele patients reporting sexual dysfunction. It is recommended to use this choice for similar patients; however, these findings should be verified by a multi-institutional study to provide more evidence for this choice.