ORIGINAL ARTICLE
Impact of varicocelectomy on premature ejaculation in varicocele patients A.-F. Ahmed1,2, A.-S. Abdel-Aziz3,4, A.M. Maarouf5,6, M. Ali1,7, A.-A. Emara1,8 & A. Gomaa1,9 1 2 3 4 5 6 7 8 9
Department Department Department Department Department Department Department Department Department
of of of of of of of of of
Urology, Urology, Urology, Urology, Urology, Urology, Urology, Urology, Urology,
Al-Azhar University, Cairo, Egypt; Salman Bin Abdul-Aziz University, Al-Kharj, Saudi Arabia; Al-Azhar University, Damietta, Egypt; Al-Rafie Hospital, Makkah, Saudi Arabia; Zagazig University, Zagazig, Egypt; King Abdullah Hospital, Bisha, Saudi Arabia; King Khalid Hospital, Tabouk, Saudi Arabia; Ghodran Hospital, Baljurashi, Saudi Arabia; Prince Sultan Armed Forces Hospital, Al Madinah, Saudi Arabia
Keywords Efficacy—premature ejaculation—varicocelectomy Correspondence Abul-fotouh Abdel-maguid Ahmed, MD, Department of Urology, Salman Bin AbdulAziz University, P.O. Box 173, Al-kharj 11942, Saudi Arabia. Tel.: +96615886100; Fax: +96615886101; E-mail: [email protected] Accepted: January 12, 2014 doi: 10.1111/and.12256
Summary In a prospective manner, we studied the effect of varicocelectomy on premature ejaculation and testicular hormonal function in patients with varicocele. Microsurgical subinguinal varicocelectomy was carried out in 73 patients with clinical varicocele associated with premature ejaculation (group 1) and compared with 56 patients without operative intervention (group 2; control). The primary efficacy variable was the mean change in the Premature Ejaculation Diagnostic Tool. The changes in International Index of Erectile Function questionnaire, total serum testosterone and testicular size were also assessed. In group 1, the Premature Ejaculation Diagnostic Tool decreased significantly after varicocelectomy, from 15.56 to 11.37 (P < 0.001), indicating improvement of premature ejaculation. Thirty patients (41.1%) showed improvement of premature ejaculation compared to 5.3% in the control group (P < 0.001). In group I, but not in group II, testosterone levels and International Index of Erectile Function values increased significantly when compared with pre-operative values (P < 0.001 and 0.040 respectively). Testicular size increased after varicocelectomy, but this increase was nonsignificant till the end of study (P = 0.054). We concluded that varicocelectomy is clearly related to improvement of premature ejaculation and testicular hormonal function in varicocele patients.
Introduction Premature ejaculation (PE), or rapid ejaculation, is one of the most common male sexual dysfunctions (Porst et al., 2007), affecting 20–30% of sexually active individuals (Laumann et al., 2005; Porst et al., 2007). Although PE adversely affects quality of life of the patient and his partner (Althof, 2006; Balde et al., 2006), relatively few studies have been conducted on PE compared to erectile dysfunction (ED). Recent evidence has suggested that certain medical conditions and urologic problems may predispose a man to PE, for example ED, hyperthyroidism, prostatitis and/or chronic pelvic pain syndrome (CPPS), monosymptomatic 276
enuresis, circumcision and varicocele (Porst et al., 2007; Lotti et al., 2009, 2012; Namavar & Robati, 2011; Corona et al., 2012; Cuceloglu et al., 2012; Gokce, 2013; Tran, 2013). Although the higher prevalence of PE in patients with varicocele has been demonstrated in several previous studies (Comhaire & Vermeulen, 1975; Younes, 2000; Ketabchi, 2008; Lotti et al., 2009), only few studies have been presented thus far linking improvement of PE and varicocele repair. In this research, we studied the relation between PE and varicocelectomy by evaluating the improvement of PE and testicular hormonal function after varicocelectomy in patients with varicocele. © 2014 Blackwell Verlag GmbH Andrologia 2015, 47, 276–281
A.-F. Ahmed et al.
Patients and methods This multicenter, prospective, nonrandomised controlled study was carried out between June 2010 and October 2013. We included patients with idiopathic varicocele, who visited the urology and andrology clinics for different genitourinary complaints. All patients underwent thorough history taking, general and genital examination, semen analysis, hormonal assessment (serum FSH, LH, Testosterone and prolactin) and scrotal colour Doppler ultrasound. Premature Ejaculation Diagnostic Tool (PEDT) (Symonds et al., 2007) and International Index of Erectile Function (IIEF-5) (Rosen et al., 1999) questionnaires were assessed for each participant. The questionnaires were validated for the Arabic language. The PEDT questionnaire includes five questions about inability of ejaculation control (IEC), frequency of IEC, ejaculation with little simulation, feel of distress and interpersonal difficulty owing to PE. Response to each question is scored on a scale from 0 to 4. PEDT total score of ≥11 was used to define PE. Varicoceles were diagnosed and graded (grade 1, 2 or 3) on the basis of physical examination and colour Doppler ultrasound. All patients were ≥18 years old, married and in a stable sexual relationship with a female partner for at least 6 months before enrolment. We excluded patients with physical or psychiatric disorders, congenital urogenital abnormalities, ED (IIEF score 0.05) (Table 1). No varicocele recurrence or serious post-operative complications were noted till the end of study. Bilateral scrotal oedema was reported in 2 (2.7%), wound infection in 1 (1.4%) and mild hydrocele in 1 (1.4%). The changes in PEDT, serum testosterone, IIEF-5 and testicular size values were evaluated in both groups after 6 months and compared with the baseline data (Table 2). In group I, the mean PEDT significantly decreased from 15.56 to 11.37 (P < 0.001); this indicates that PEDT significantly improved by 26.93%. Thirty patients (41.1%) in group I showed improvement of PE (PEDT
Impact of varicocelectomy on premature ejaculation in varicocele patients A.-F. Ahmed1,2, A.-S. Abdel-Aziz3,4, A.M. Maarouf5,6, M. Ali1,7, A.-A. Emara1,8 & A. Gomaa1,9 1 2 3 4 5 6 7 8 9
Department Department Department Department Department Department Department Department Department
of of of of of of of of of
Urology, Urology, Urology, Urology, Urology, Urology, Urology, Urology, Urology,
Al-Azhar University, Cairo, Egypt; Salman Bin Abdul-Aziz University, Al-Kharj, Saudi Arabia; Al-Azhar University, Damietta, Egypt; Al-Rafie Hospital, Makkah, Saudi Arabia; Zagazig University, Zagazig, Egypt; King Abdullah Hospital, Bisha, Saudi Arabia; King Khalid Hospital, Tabouk, Saudi Arabia; Ghodran Hospital, Baljurashi, Saudi Arabia; Prince Sultan Armed Forces Hospital, Al Madinah, Saudi Arabia
Keywords Efficacy—premature ejaculation—varicocelectomy Correspondence Abul-fotouh Abdel-maguid Ahmed, MD, Department of Urology, Salman Bin AbdulAziz University, P.O. Box 173, Al-kharj 11942, Saudi Arabia. Tel.: +96615886100; Fax: +96615886101; E-mail: [email protected] Accepted: January 12, 2014 doi: 10.1111/and.12256
Summary In a prospective manner, we studied the effect of varicocelectomy on premature ejaculation and testicular hormonal function in patients with varicocele. Microsurgical subinguinal varicocelectomy was carried out in 73 patients with clinical varicocele associated with premature ejaculation (group 1) and compared with 56 patients without operative intervention (group 2; control). The primary efficacy variable was the mean change in the Premature Ejaculation Diagnostic Tool. The changes in International Index of Erectile Function questionnaire, total serum testosterone and testicular size were also assessed. In group 1, the Premature Ejaculation Diagnostic Tool decreased significantly after varicocelectomy, from 15.56 to 11.37 (P < 0.001), indicating improvement of premature ejaculation. Thirty patients (41.1%) showed improvement of premature ejaculation compared to 5.3% in the control group (P < 0.001). In group I, but not in group II, testosterone levels and International Index of Erectile Function values increased significantly when compared with pre-operative values (P < 0.001 and 0.040 respectively). Testicular size increased after varicocelectomy, but this increase was nonsignificant till the end of study (P = 0.054). We concluded that varicocelectomy is clearly related to improvement of premature ejaculation and testicular hormonal function in varicocele patients.
Introduction Premature ejaculation (PE), or rapid ejaculation, is one of the most common male sexual dysfunctions (Porst et al., 2007), affecting 20–30% of sexually active individuals (Laumann et al., 2005; Porst et al., 2007). Although PE adversely affects quality of life of the patient and his partner (Althof, 2006; Balde et al., 2006), relatively few studies have been conducted on PE compared to erectile dysfunction (ED). Recent evidence has suggested that certain medical conditions and urologic problems may predispose a man to PE, for example ED, hyperthyroidism, prostatitis and/or chronic pelvic pain syndrome (CPPS), monosymptomatic 276
enuresis, circumcision and varicocele (Porst et al., 2007; Lotti et al., 2009, 2012; Namavar & Robati, 2011; Corona et al., 2012; Cuceloglu et al., 2012; Gokce, 2013; Tran, 2013). Although the higher prevalence of PE in patients with varicocele has been demonstrated in several previous studies (Comhaire & Vermeulen, 1975; Younes, 2000; Ketabchi, 2008; Lotti et al., 2009), only few studies have been presented thus far linking improvement of PE and varicocele repair. In this research, we studied the relation between PE and varicocelectomy by evaluating the improvement of PE and testicular hormonal function after varicocelectomy in patients with varicocele. © 2014 Blackwell Verlag GmbH Andrologia 2015, 47, 276–281
A.-F. Ahmed et al.
Patients and methods This multicenter, prospective, nonrandomised controlled study was carried out between June 2010 and October 2013. We included patients with idiopathic varicocele, who visited the urology and andrology clinics for different genitourinary complaints. All patients underwent thorough history taking, general and genital examination, semen analysis, hormonal assessment (serum FSH, LH, Testosterone and prolactin) and scrotal colour Doppler ultrasound. Premature Ejaculation Diagnostic Tool (PEDT) (Symonds et al., 2007) and International Index of Erectile Function (IIEF-5) (Rosen et al., 1999) questionnaires were assessed for each participant. The questionnaires were validated for the Arabic language. The PEDT questionnaire includes five questions about inability of ejaculation control (IEC), frequency of IEC, ejaculation with little simulation, feel of distress and interpersonal difficulty owing to PE. Response to each question is scored on a scale from 0 to 4. PEDT total score of ≥11 was used to define PE. Varicoceles were diagnosed and graded (grade 1, 2 or 3) on the basis of physical examination and colour Doppler ultrasound. All patients were ≥18 years old, married and in a stable sexual relationship with a female partner for at least 6 months before enrolment. We excluded patients with physical or psychiatric disorders, congenital urogenital abnormalities, ED (IIEF score 0.05) (Table 1). No varicocele recurrence or serious post-operative complications were noted till the end of study. Bilateral scrotal oedema was reported in 2 (2.7%), wound infection in 1 (1.4%) and mild hydrocele in 1 (1.4%). The changes in PEDT, serum testosterone, IIEF-5 and testicular size values were evaluated in both groups after 6 months and compared with the baseline data (Table 2). In group I, the mean PEDT significantly decreased from 15.56 to 11.37 (P < 0.001); this indicates that PEDT significantly improved by 26.93%. Thirty patients (41.1%) in group I showed improvement of PE (PEDT
