Effect of surgical repair on testosterone production in infertile men with varicocele: a meta-analysis.

OBJECTIVES: To determine the effect of surgical varicocele repair in improving testicular Leydig cell function as shown by increased testosterone production. METHODS: Eligible studies were searched in Medline and the Pubmed database, and cross-referenced as of 31 May 2011 using the terms "varicocele,""testosterone" and "surgery." The database search, quality assessment and data extraction were independently carried out by two reviewers. Only studies including patients with testosterone evaluation before and after surgery were considered for the analysis. A systematic review and meta-analysis was carried out for continues variables using random effect models. RESULTS: Out of 125 studies, a total of nine were selected, including 814 patients. The combined analysis showed that mean serum testosterone levels after surgical treatment increased by 97.48 ng/dL (95% confidence interval 43.73-151.22, P=0.0004) compared with preoperative levels. CONCLUSIONS: Surgical treatment of varicocele significantly increases testosterone production and improves testicular Leydig cell function.