Treatment of Palpable Varicocele in Infertile Men: A Meta‐analysis to Define the Best Technique

Abstract

To date, there have been no randomized, controlled, prospective clinical studies that compare various techniques to describe the best method for the treatment of varicocele in infertile men. This meta-analysis aims to address the best treatment modality for palpable varicocele in infertile men. A MEDLINE search was performed for articles published between January 1980 and April 2008, and we analyzed 36 studies reporting postoperative spontaneous pregnancy rates and/or complication rates after varicocele repair using various techniques in infertile men with palpable unilateral or bilateral varicocele. Spontaneous pregnancy rates and postoperative complications such as hydrocele formation, recurrence, or persistence were compared among the techniques. In addition, interventional failure with radiologic embolization and reported complications with the laparoscopic approach were reviewed. Overall spontaneous pregnancy rates were 37.69% in the Palomo technique series, 41.97% in the microsurgical varicocelectomy techniques, 30.07% in the laparoscopic varicocelectomy techniques, 33.2% in the radiologic embolization, and 36% in the macroscopic inguinal (Ivanissevich) varicocelectomy series, revealing significant differences among the techniques (P 5 .001). Overall recurrence rates were 14.97% in the Palomo technique series, 1.05% in the microsurgical varicocelectomy techniques, 4.3% in the laparoscopic varicocelectomy techniques, 12.7% in the radiologic embolization, and 2.63% in the macroscopic inguinal (Ivanissevich) or subinguinal varicocelectomy series, revealing significant difference among the techniques (P 5 .001). Overall hydrocele formation rates were 8.24% in the Palomo technique series, 0.44% in the microsurgical varicocelectomy techniques, 2.84% in the laparoscopic varicocelectomy, and 7.3% in the macroscopic inguinal (Ivanissevich) or subinguinal varicocelectomy series, revealing significant difference among the techniques (P 5 .001). We conclude that the microsurgical varicocelectomy technique has higher spontaneous pregnancy rates and lower postoperative recurrence and hydrocele formation than conventional varicocelectomy techniques in infertile men. However, prospective, randomized, and comparative studies with large number of patients are needed to compare the efficacy of microsurgical varicocelectomy with that of other treatment modalities in infertile men with varicocele.

Varicocele and Male Infertility: Current Issues in Management-A Review

“…Percutaneous embolization offers a rapid recovery and can give good success rate, but the technique demands interventional radiologic expertise and has potential serious complications, including vascular perforation, coil migration, thrombosis of pampiniform plexus [64,65]. Lima et al have recently pioneered natural orifice transluminal endoscopic surgical procedures (NOTES) to perform varicocelectomy as an important minimally invasive approach [66,67].…”

“…However, there is no objective data to substantiate a clear advantage of one over the other. Cayan et al [65] in a systematic review involving 4,473 men aimed to define the best modality of treatment in palpable varicocele in infertile men. The authors concluded that open inguinal or subinguinal artery and lymphatic sparing microsurgical techniques resulted in higher spontaneous pregnancy rate, fewer recurrence and complications compared to laparoscopic, radiologic embolisation, macroscopic inguinal or retroperitoneal procedures.…”

“…The authors concluded that open inguinal or subinguinal artery and lymphatic sparing microsurgical techniques resulted in higher spontaneous pregnancy rate, fewer recurrence and complications compared to laparoscopic, radiologic embolisation, macroscopic inguinal or retroperitoneal procedures. Varicocelectomy is believed to improve one or more semen parameters in 65% of those men who are treated [65]. In a recent meta-analysis study conducted by Borruto et al [72] surgical approaches and postoperative complications were compared between the classic open surgical techniques and minimal invasive surgical approaches.…”

What is New in the Clinical Assessment and Treatment of the Infertile Male

“…The inguinal (Ivanissevich) and subinguinal approaches also allow the ligation of the external spermatic and cremasteric veins that may contribute to the varicocele. A recent systematic review including 4,473 infertile individuals was performed to define the best treatment modality for varicocele [53]. The authors concluded that open microsurgical inguinal or subinguinal varicocelectomy techniques resulted in higher spontaneous pregnancy rates and fewer recurrences and postoperative complications than laparoscopic, radiologic embolization and macroscopic inguinal or retroperitoneal varicocelectomy techniques (Fig.…”

Method of surgical treatment of varicocele

“…Нарушение фертиль-ности при варикоцеле отмечается в 20-80% случаев, а среди пациентов, страдающих бесплодием, варико-целе выявлено у 30-40%. Связь варикоцеле с бес-e-mail: rasulovjamshid@mail.ru плодием явилась основной причиной включения данной патологии в число программ, разрабатывае-мых ВОЗ [2,5,7].Различают непрямые и прямые комбинирован-ные способы хирургического лечения варикоцеле. Прямые способы операции на венах семенного ка- Цель исследования -улучшить результаты хирургического лечения варикоцеле путем разработки способов с использованием микрохирургической техники.…”