Systematic review of treatment methods for recurrent varicoceles to compare post‐treatment sperm parameters, pregnancy and complication rates

Abstract

We aimed to define which method would be the best for the treatment of recurrent varicoceles. We analysed 21 studies to compare post‐treatment improvement in semen parameters, spontaneous pregnancy and complication rates between the treatment methods. Overall spontaneous pregnancy rate was significantly higher in the surgical methods (44.3%) than in the radiological interventions (17.9%; p = .007). Post‐treatment improvement rates in sperm parameters were significantly higher in the open surgical methods (77.5%) than in the radiological interventions (62.5%; p = .032). Post‐treatment recurrence rates were 3.8% in the open surgical methods, 17.6% in the laparoscopic surgery and 3.3% in the radiological interventions. However, technical failure rate was 11.8% in the radiologic interventions. To analyse open surgical methods, recurrence rate was 0.6% in the microsurgical methods and 19% in the macroscopic methods, revealing significant difference (p < .001). Post‐treatment testicular atrophy rate was significantly higher in the laparoscopic surgery (2.9%) than in the open surgery (0.3%; p = .033). In conclusion, surgical methods have higher pregnancy rates and higher improvement rate in sperm parameters than radiological interventions for the treatment of recurrent varicocele. Microsurgical redo varicocelectomy has lower recurrence and testicular atrophy rates than macroscopic varicocelectomy series. Therefore, patients with recurrent varicoceles should be informed based on these findings.

Improvement of sperm morphology after surgical varicocele repair

“…The surgical procedure presented a relapse rate of 12.4% (15 cases on 121) in our casuistry, independently of the technique applied. This rate is in line with data available in the literature 46 …”

“…This rate is in line with data available in the literature. 46 Our study has several limits, such as the retrospective study design and the imbalance among surgical approaches. Indeed, the study does not provide a case-control approach to compare the surgical techniques.…”

Effect of microsurgical varicocele repair on sexual functions and testosterone in hypogonadal infertile men with varicocele

“…If treatment of varicocele is preferred, improvement of testosterone level will take some time, and if ART is preferred to conceive, testosterone treatment might be given to these hypogonadal men for hypogonadism related symptoms [8,9]. Varicocele in hypogonadal men can be treated via open surgery, radiologic interventions and laparoscopic approaches [24,25]. When all the methods in the literature are compared, microsurgical varicocelectomy provides the lowest complications rates, including varicocele recurrence, testicular atrophy and hydrocele formation, compared to other varicocelectomy methods.…”

Bilateral persistent sinus tracts formation post bilateral microsurgical inguinal varicocelectomy: A case report

“…A recent meta-analysis showed that the rate of wound infection and hematoma post varicocelectomy has the lowest rate of 1.1% with microsurgical approach. 4 However, a one center study was conducted to examine the return to the hospital after ambulatory surgery discharge showed that patients underwent varicocelectomy and hydrocelectomy are 8.3 times more likely to return to the hospital than other ambulatory surgeries, two-thirds of them were evaluated for infections and fever. 5 …”