Inguinal and subinguinal micro-varicocelectomy, the optimal surgical management of varicocele: a meta-analysis

Abstract

Conventional meta-analyses have shown inconsistent results for the efficacy of various treatments of varicoceles. Therefore, we performed a multiple-treatment meta-analysis to assess the effectiveness and safety of 10 methods of varicocelectomy and embolization/sclerotherapy. We systematically reviewed 35 randomized controlled trials and observational studies, from 1966 to August 5, 2013, which compared any of the following treatments for varococeles: laparoscopic, retroperitoneal, open inguinal and subinguinal varicocelectomy, microsurgical subinguinal and inguinal varicocelectomy, percutaneous venous embolization, Tauber antegrade sclerotherapy, retrograde sclerotherapy and expectant therapy (no treatment). Inguinal and subinguinal microsurgery, open inguinal, laparoscopic varicocelectomy showed a significant advantage over expectant therapy in terms of pregnancy rates (odds ratio (OR): 3.48, 2.68, 2.92 and 2.90, respectively). Compared with retroperitoneal open surgery, inguinal microsurgery showed an improvement of sperm density (mean difference (MD): 10.60, 95% confidence interval (CI): 1.92–19.60) and sperm motility (MD: 9.09, 95% CI: 4.88–13.30). Subinguinal and inguinal microsurgery outperformed retroperitoneal open surgery in terms of recurrence (OR: 0.05, 0.06 respectively). Tauber antegrade sclerotherapy and subinguinal microsurgery were associated with the lowest risk of hydrocele formation. The odds of overall complication, compared with retroperitoneal open varicocelectomy, were lowest for inguinal microsurgery (OR = 0.07, 95% CI: 0.02–0.19), followed by subinguinal microsurgery (OR = 0.09, 95% CI: 0.02–0.19). Inguinal and subinguinal micro-varicocelectomy had the highest pregnancy rates, significant increases in sperm parameters, with low odds of complication. These results warrant additional properly conducted randomized controlled clinical studies with larger sample sizes.

Subinguinal microsurgical varicocelectomy vs. percutaneous embolization in infertile men: Prospective comparison of reproductive and functional outcomes

“…They also clearly highlighted the impact of varicocele treatment on all semen parameters (compared to controls, OR = 12.3 (9.45 – 15.19) for sperm concentration, 0.86 (7.07 – 14.65) for total motility, 9.69 (4.86 – 14.52) for progressive motility [5]. This positive impact of varicocele treatment on semen parameters has been supported by two recent meta-analyses [22, 23]. Moreover, Baazzem et al included in their study new interesting end points that were not analyzed previously, and that were improved following the treatment (oxidative stress, sperm DNA damage, sperm ultrastructure) [5].…”

Comparison of clinical outcome of bilateral and unilateral varicocelectomy in infertile males with left clinical and right subclinical varicocele: A meta-analysis of randomised controlled trials

“…On the contrary, a non-RCT including 91 infertile males with bilateral clinical varicocele (grades 2 to 3 on the left side and grade 1 on the right side) indicated that bilateral varicocelectomy was superior to left varicocelectomy in total sperm count, sperm concentration and motility (Scherr & Goldstein, 1999). Thus, the treatment of (Wang et al, 2015).…”

Antegrade scrotal sclerotherapy of internal spermatic veins for varicocele treatment: technique, complications, and results

“…A recent meta-analysis published by Wang et al . 13 showed that ASS and microsurgical repair are superior to other techniques (open retroperitoneal surgery, laparoscopic approach) in terms of hydrocele formation. The lower risk of hydrocele formation for ASS in comparison with open surgical approach was previously highlighted by a randomized prospective study.…”