CURRENTOPINION Varicocele repair for low testosterone

Varicocele isanabnormalenlargementof the internal spermatic vein and pampiniform plexus of the testis. Most urologists believe that varicoceles arise from incompetent or absence of valves within the major veins of the testis, although other etiological factors nodoubtplaya role [1].Varicocele typicallyoccurson the left side, but bilateral varicoceles occur in more than 50% of patients [2]. In the general male population, the prevalence of varicocele is between 10 and 15%, but is as high as 40% among menwith infertility [3]. It is likely that the pathophysiological processes that promote varicocele begin as early as puberty because the incidence of varicocele in adolescents is similar to that of adults [4]. The association of varicocele and male infertility has been known for more than a century [5] and varicocele is now regarded as the leading cause of male infertility [6 && ]. The effect of varicocele on testosterone levels, however, has not been as well studied or defined. The studies conducted prior to 2011 have yielded results that are difficult to interpret, which has led to equivocal statements about the utility of varicocele repair for correcting hypogonadal levels of testosterone. Several recent studies, however, haveproducedconsistent evidence forboth the harmful effects of varicocele on testosterone production and for the restoration of normal