Gorelick JI, Goldstein M. Loss of fertility in men with varicocele. Fertil Steril. 1993;59:613–6.
Kass EJ, Belman AB. Reversal of testicular growth failure by varicocele ligation. J Urol. 1987;137:475–6.
Dubin L, Amelar RD. Varicocelectomy: 986 cases in a twelve-year study. Urology. 1977;10:446–9.
•• Goldstein M, Gilbert BR, Dicker AP, Dwosh J, Gnecco C. Microsurgical inguinal varicocelectomy with delivery of the testis: an artery and lymphatic sparing technique. J Urol. 1992;148:1808–11. The importance of the microsurgical technique is highlighted with decreased incidence of hydrocele formation, ligation of the testicular artery, and varicocele recurrence.
Su LM, Goldstein M, Schlegel PN. The effect of varicocelectomy on serum testosterone levels in infertile men with varicoceles. J Urol. 1995;154:1752–5.
Mehraban D, Ansari M, Keyhan H, Sedighi Gilani M, Naderi G, Esfehani F. Comparison of nitric oxide concentration in seminal fluid between infertile patients with and without varicocele and normal fertile men. Urology. 2005;2:106–10.
Mostafa T, Anis TH, El-Nashar A, Imam H, Othman IA. Varicocelectomy reduces reactive oxygen species levels and increases antioxidant activity of seminal plasma from infertile men with varicocele. Int J Androl. 2001;24:261–5.
Santoro G, Romeo C, Impellizzeri P, et al. Nitric oxide synthase patterns in normal and varicocele testis in adolescents. BJU Int. 2001;88:967–73.
Khera M, Lipshultz LI. Evolving approach to the varicocele. Urol Clin. 2008;35:183–9. viii.
Goldstein M, Eid JF. Elevation of intratesticular and scrotal skin surface temperature in men with varicocele. J Urol. 1989;142:743–5.
Rajfer J, Turner TT, Rivera F, Howards SS, Sikka SC. Inhibition of testicular testosterone biosynthesis following experimental varicocele in rats. Biol Reprod. 1987;36:933–7.
Takeyama M, Honjoh M, Kodama M, et al. Testicular steroids in spermatic and peripheral veins after single injection of hCG in patients with varicocele. Arch Androl. 1990;24:207–13.
Boujrad N, Guillaumin JM, Bardos P, de Reviers MT H, Drosdowsky MA, Carreau S. Germ cell-Sertoli cell interactions and production of testosterone by purified Leydig cells from mature rat. J Steroid Biochem Mol Biol. 1992;41:677–81.
Ito H, Fuse H, Minagawa H, Kawamura K, Murakami M, Shimazaki J. Internal spermatic vein prostaglandins in varicocele patients. Fertil Steril. 1982;37:218–22.
Sirvent JJ, Bernat R, Navarro MA, Rodriguez Tolra J, Guspi R, Bosch R. Leydig cell in idiopathic varicocele. Eur Urol. 1990;17:257–61.
Bennett WH. A Clinical Lecture on some Points Relating to Varicocele: Delivered at St. George's Hospital. Br Med J. 1901;1:501–4.
Wright EJ, Young GP, Goldstein M. Reduction in testicular temperature after varicocelectomy in infertile men. Urology. 1997;50:257–9.
Goldstein M, Schlegel PN. Surgical and medical management of male infertility. Cambridge: Cambridge University Press; 2013.
• Marmar JL, Kim Y. Subinguinal microsurgical varicocelectomy: a technical critique and statistical analysis of semen and pregnancy data. J Urol. 1994;152:1127–32. The subinguinal approach for varicocelectomy is associated with minimal morbidity and beneficial pregnancy outcomes.
Wosnitzer M, Roth JA. Optical magnification and Doppler ultrasound probe for varicocelectomy. Urology. 1983;22:24–6.
Yamamoto M, Hibi H, Hirata Y, Miyake K, Ishigaki T. Effect of varicocelectomy on sperm parameters and pregnancy rate in patients with subclinical varicocele: a randomized prospective controlled study. J Urol. 1996;155:1636–8.
Zini A, Blumenfeld A, Libman J, Willis J. Beneficial effect of microsurgical varicocelectomy on human sperm DNA integrity. Hum Reprod. 2005;20:1018–21.
Marmar JL, Agarwal A, Prabakaran S, et al. Reassessing the value of varicocelectomy as a treatment for male subfertility with a new meta-analysis. Fertil Steril. 2007;88:639–48.
Zheng YQ, Zhang XB, Zhou JQ, Cheng F, Rao T, Yao Y. The effects of artery-ligating and artery-preserving varicocelectomy on the ipsilateral testes in rats. Urology. 2008;72:1179–84.
Orwoll E, Lambert LC, Marshall LM, et al. Testosterone and estradiol among older men. J Clin Endocrinol Metabol. 2006;91:1336–44.
Harman SM, Metter EJ, Tobin JD, Pearson J, Blackman MR. Longitudinal effects of aging on serum total and free testosterone levels in healthy men. Baltimore Longitudinal Study of Aging. J Clin Endocrinol Metabol. 2001;86:724–31.
Comhaire F, Vermeulen A. Plasma testosterone in patients with varicocele and sexual inadequacy. J Clin Endocrinol Metabol. 1975;40:824–9.
Pirke KM, Vogt HJ, Sintermann R, Spyra B. Testosterone in peripheral plasma, spermatic vein and in testicular tissue under basal conditions and after HCG-stimulation in patients with varicocele. Andrologia. 1983;15:637–41.
•• Tanrikut C, Goldstein M, Rosoff JS, Lee RK, Nelson CJ, Mulhall JP. Varicocele as a risk factor for androgen deficiency and effect of repair. BJU Int. 2011;108:1480–4. This reference indicates that varicocele is a significant risk factor for hypogonadism and that microsurgical varicocele ligation resulted in a significant increase in serum testosterone levels in greater than 2/3 of men.
Di Bisceglie C, Bertagna A, Baldi M, et al. Varicocele sclerotherapy improves serum inhibin B levels and seminal parameters. Int J Androl. 2007;30:531–6.
de Catalfo GE H, Ranieri-Casilla A, Marra FA, de Alaniz MJ, Marra CA. Oxidative stress biomarkers and hormonal profile in human patients undergoing varicocelectomy. Int J Androl. 2007;30:519–30.
Rodriguez Pena M, Alescio L, Russell A, Lourenco da Cunha J, Alzu G, Bardoneschi E. Predictors of improved seminal parameters and fertility after varicocele repair in young adults. Andrologia. 2009;41:277–81.
Zheng YQ, Gao X, Li ZJ, Yu YL, Zhang ZG, Li W. Efficacy of bilateral and left varicocelectomy in infertile men with left clinical and right subclinical varicoceles: a comparative study. Urology. 2009;73:1236–40.
Ozden C, Ozdal OL, Bulut S, Guzel O, Koyuncu HH, Memis A. Effect of varicocelectomy on serum inhibin B levels in infertile patients with varicocele. Scand J Urol Nephrol. 2008;42:441–3.
Lee RK, Li PS, Goldstein M. Simultaneous vasectomy and varicocelectomy: indications and technique. Urology. 2007;70:362–5.
Li F, Yue H, Yamaguchi K, et al. Effect of surgical repair on testosterone production in infertile men with varicocele: a meta-analysis. Int J Urol. 2012;19:149–54.
Sathya Srini V, Belur Veerachari S. Does varicocelectomy improve gonadal function in men with hypogonadism and infertility? Analysis of a prospective study. Int J Endocrinol. 2011;2011:916380
Zohdy W, Ghazi S, Arafa M. Impact of varicocelectomy on gonadal and erectile functions in men with hypogonadism and infertility. J Sex Med. 2011;8:885–93.
•• Hsiao W, Rosoff JS, Pale JR, Greenwood EA, Goldstein M. Older age is associated with similar improvements in semen parameters and testosterone after subinguinal microsurgical varicocelectomy. J Urol. 2011;185:620–5. Microsurgical varicocelectomy significantly improved sperm concentration, total sperm count and testosterone in all age groups studied, including men in the fifth and sixth decades of life. This study substantiates that microsurgical varicocelectomy is appropriate treatment for older men for infertility and/or hypogonadism.
Resorlu B, Kara C, Sahin E, Unsal A. The significance of age on success of surgery for patients with varicocele. Int Urol Nephrol. 2010;42:351–6.
Witt MA, Lipshultz LI. Varicocele: a progressive or static lesion? Urology. 1993;42:541–3.
Steckel J, Dicker AP, Goldstein M. Relationship between varicocele size and response to varicocelectomy. J Urol. 1993;149:769–71.
Gat Y, Gornish M, Belenky A, Bachar GN. Elevation of serum testosterone and free testosterone after embolization of the internal spermatic vein for the treatment of varicocele in infertile men. Hum Reprod. 2004;19:2303–6.
Al-Ali BM, Marszalek M, Shamloul R, Pummer K, Trummer H. Clinical parameters and semen analysis in 716 Austrian patients with varicocele. Urology. 2010;75:1069–73.
Shiraishi K, Takihara H, Matsuyama H. Elevated scrotal temperature, but not varicocele grade, reflects testicular oxidative stress-mediated apoptosis. World J Urol. 2010;28:359–64.
Buttke TM, Sandstrom PA. Oxidative stress as a mediator of apoptosis. Immunol Today. 1994;15:7–10.
Rogers RS, Graziottin TM, Lin CS, Kan YW, Lue TF. Intracavernosal vascular endothelial growth factor (VEGF) injection and adeno-associated virus-mediated VEGF gene therapy prevent and reverse venogenic erectile dysfunction in rats. Int J Impot Res. 2003;15:26–37.
Meusburger SM, Keast JR. Testosterone and nerve growth factor have distinct but interacting effects on structure and neurotransmitter expression of adult pelvic ganglion cells in vitro. Neuroscience. 2001;108:331–40.
Baba K, Yajima M, Carrier S, et al. Delayed testosterone replacement restores nitric oxide synthase-containing nerve fibres and the erectile response in rat penis. BJU Int. 2000;85:953–8.
Seo SI, Kim SW, Paick JS. The effects of androgen on penile reflex, erectile response to electrical stimulation and penile NOS activity in the rat. Asian J Androl. 1999;1:169–74.
Lugg JA, Rajfer J, Gonzalez-Cadavid NF. Dihydrotestosterone is the active androgen in the maintenance of nitric oxide-mediated penile erection in the rat. Endocrinology. 1995;136:1495–501.
Traish AM, Park K, Dhir V, Kim NN, Moreland RB, Goldstein I. Effects of castration and androgen replacement on erectile function in a rabbit model. Endocrinology. 1999;140:1861–8.