[Gonadotropin-releasing hormone (GnRH) in selecting patients for varicocelectomy].
The gonadotropin-releasing hormone (GnRH) test was performed on 182 patients with various degrees of varicocele before and after low, inguinal, spermatic vein ligation, and on 18 controls. The levels of follicle-stimulating hormone (FSH) and luteinizing hormone, a synthetic GnRH (LH), were evaluated before and 45 minutes after intravenous injection of 100 mcg relisorm L. FSH levels increased more than 2-fold in 118 patients [64.8%] and LH levels increased more than 5-fold in 135 patients [74.1%]). In the control group the increase was less in all cases. Therefore, whenever FSH increased more than 2-fold and LH more than 5-fold, we considered the test positive (pathologic); On this basis the GnRH test was positive in 126 (69.2%) and negative (normal) in 56 (30.7%). Of the 126 with positive tests, only 32 (27.3%) still had a positive result 5-6 months after operation. There was correlation between a positive GnRH test and significant improvement in sperm parameters after varicocelectomy: of the 126 with positive tests before operation, sperm parameters improved in 87 patients (69%), while in the 56 patients with negative tests before operation, in only 7 (12.5%) was there improvement after correction. We conclude that a positive GnRH test indicates impairment of the hypothalamic-pituitary-gonadal axis caused by varicocele and could serve as a marker for surgical intervention with good prediction of outcome.
Segenreich
E
E
Andrology Unit, Institute of Urology, Rabin Medical Center, Petah Tikva.
Israilov
S
S
Shmueli
J
J
Niv
E
E
Servadio
C
C
D005640:Follicle Stimulating Hormone / Q000097:blood*; D007987:Gonadotropin-Releasing Hormone; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D007986:Luteinizing Hormone / Q000097:blood*; D008297:Male; D018579:Patient Selection; D010913:Pituitary-Adrenal System / Q000503:physiopathology; D016896:Treatment Outcome; D014646:Varicocele / Q000097:blood* / Q000503:physiopathology / Q000601:surgery*
D007987:Gonadotropin-Releasing Hormone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone