Asymptomatic Male with Grade 3 Left Varicocele and Two Children with Low Testosterone Levels Desiring Vasectomy

Abstract

When the desire for family planning through vasectomy is associated with an asymptomatic clinical varicocele (grade 2 or 3) and low total serum testosterone levels, it is recommended that the surgeon report the possible postsurgical clinical consequences, in addition to inherent risks of vasectomy. In this way, the physician needs to be able to discuss the surgical treatment best suited to the patient’s clinical needs.

In this chapter, to better understand the consequences that a vasectomy might cause on patients with clinical varicocele and low testosterone level, we will cover the following subjects: (i) a review of testicular arterial supply, (ii) a literature review about clinical varicocele and low levels of testosterone production, (iii) better understanding of varicocele repair and the impact on the androgenic hormonal balance, and (iv) discussion on possible negative impact on testosterone production after vasectomy in patients with high-grade clinical varicocele and low testosterone level. Finally, the authors will propose a differentiated surgical approach for patients in this case scenario. This surgical procedure will offer the acquisition of a safe contraceptive method and, concurrently, increasing the chances of improvement of the total testosterone level, providing possible delay or even elimination of the risk of hypogonadism.