Association between varicocele and hypogonadism, or erectile dysfunction: A systematic review and meta-analysis

• Published in: Actas urológicas españolas (English ed.) 2024-12, Vol.48 (10), p.751-759
• Main Authors: Gonzalez-Daza, S.J., Díaz-Hung, A.M., García-Perdomo, H.A.
• Format: Article
• Language: English
• Subjects: Deficiencia de testosterona; Disfunción eréctil; Erectile dysfunction; Erectile Dysfunction - epidemiology; Erectile Dysfunction - etiology; Hipogonadismo; Humans; Hypogonadism; Hypogonadism - complications; Hypogonadism - epidemiology; Male; Testosterone deficiency; Varicocele; Varicocele - complications; Varicocele - epidemiology
• ISSN: 2173-5786; 2173-5786
• DOI: 10.1016/j.acuroe.2024.06.006

[Display omitted] To assess the association between varicocele and hypogonadism, or erectile dysfunction. We searched MEDLINE, EMBASE, LILACS, CENTRAL, and other sources. We included cohort, case-control, and cross-sectional studies. The primary outcome was the association between varicocele and hypogonadism, or erectile dysfunction, and the secondary outcome included semen analysis. We assessed the risk of bias with the Newcastle-Ottawa Scale. We performed statistical analysis in Review Manager 5.3 and reported information about the Odds Ratio (OR) with a 95% confidence interval. We produced a forest plot for the primary outcome. We included ten studies in qualitative analysis and six studies in quantitative analysis. Most of the cross-sectional studies showed a low risk of bias, not so for the two case-control studies, which represented a high risk of bias. Most of the reports described a correlation between having varicocele and presenting low testosterone levels: the meta-analysis showed that there is a significant association between varicocele and hypogonadism (OR 3.27 95% CI 1.23 to 8.68). Regarding varicocele and erectile, only one study showed a significant difference in erectile function in comparison to varicocele patients and men without varicocele. There is an association between varicocele presence and hypogonadism, although more studies are needed. Besides, not much is reported about an association between varicocele and erectile dysfunction, but impairment can occur through hormone disturbances. Se realizó una revisión sistemática y un metaanálisis para evaluar la relación entre el varicocele y el hipogonadismo o la disfunción eréctil. Se realizaron búsquedas en MEDLINE, EMBASE, LILACS, CENTRAL y otras fuentes. Se incluyeron estudios de cohortes, de casos y controles y transversales. La variable principal de valoración fue la relación entre el varicocele y el hipogonadismo o la disfunción eréctil, y la variable secundaria de valoración incluyó el espermograma. Se utilizó la escala Newcastle-Ottawa para evaluar el riesgo de sesgo. Para el análisis estadístico se utilizó Review Manager 5.3 y se proporcionaron los valores de odds ratio (OR) con un intervalo de confianza del 95%. Se elaboró un diagrama de bosque para la variable principal. Se incluyeron diez estudios en el análisis cualitativo y seis en el cuantitativo. La mayoría de los estudios transversales mostraron un riesgo de sesgo bajo, no así los dos estudios de casos y controles, que