Bilateral is superior to unilateral varicocelectomy in infertile men with bilateral varicocele: Systematic review and meta‐analysis

Ou, Ningjing; Jun, Zhu; Zhang, Wei; Liang, Zhen; Hu, Rui; Song, Yuxuan; Yang, Yongjiao; Liu, Xiaoqiang

doi:10.1111/and.13462

Cited by 12 publications

(7 citation statements)

References 22 publications

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“…Studies have suggested that there is a difference in spermatogenesis between unilateral varicocele and bilateral varicocele after treatment ( Niu et al, 2018 ; Ou et al, 2019 ). One prospective randomized controlled study found that bilateral varicocele surgery was more effective than unilateral surgery ( Sun et al, 2018 ).…”

Section: Discussionmentioning

confidence: 99%

Jiawei Runjing Decoction Improves Spermatogenesis of Cryptozoospermia With Varicocele by Regulating the Testicular Microenvironment: Two-Center Prospective Cohort Study

Liu

Huang

Zheng³

et al. 2022

Front. Pharmacol.

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Objective: The aim of the study was to explore the evidence of JWRJD in the treatment of cryptozoospermia.Methods: A total of 162 cryptozoospermia patients with varicocele who refused to undergo surgery were included from January 2021 to December 2021. They were divided into the Jiawei Runjing Decoction group (group A), tamoxifen group (group B), and no treatment group (group C), and after the follow-up for 3 months, therapeutic effectiveness was compared. Network pharmacology was used to analyze and validate the effects and mechanisms of JWRJD.Results: Fifty-eight patients were treated with JWRJD, 55 with tamoxifen, and 49 without any treatment. After treatment, five patients were lost: one in group A, one in group B, and three in group C. The sperm count and the decrease of FSH in group A were significantly higher, but the degree of decline in the testicular volume and the degree of vein expansion have decreased significantly, which were closely related to the testicular volume (TV) [especially changes in the left testicular volume (ΔL-TV)], citric acid (CC) and its changes (ΔCC), and the vein width (VW) [especially left spermatic vein width (L-VW) and mean vein width (M-VW) and their changes (ΔL-VW and ΔM-VW)], as well as the sperm count before the treatment (bSC), which were the significant indexes to predict the therapeutic effect, especially for patients >35 years old and with grade III varicoceles. Network pharmacological analysis verifies that it can be regulated by fluid shear stress and the atherosclerosis pathway to improve the testicular microenvironment for spermatogenesis.Conclusion: JWRJD may promote spermatogenesis in cryptozoospermia patients with varicocele, which may be closely related to improving the testicular microenvironment, especially for >35 year olds and grade III varicocele patients.

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Section: Discussionmentioning

confidence: 99%

Jiawei Runjing Decoction Improves Spermatogenesis of Cryptozoospermia With Varicocele by Regulating the Testicular Microenvironment: Two-Center Prospective Cohort Study

Liu

Huang

Zheng³

et al. 2022

Front. Pharmacol.

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“…Similarly, the effects of varicocelectomy on semen parameters were also controversial. Several meta‐analyses were conducted and updated constantly to generate high‐grade evidence to verify the positive effect of varicocelectomy to varicocele‐related infertility men (Birowo et al., 2020; Ou et al., 2019; Schaueret al, 2012). Clearly, whether varicocelectomy could improve semen quality still needed further well‐designed studies to explore.…”

Section: Discussionmentioning

confidence: 99%

Effect of varicocele on sperm DNA damage: A systematic review and meta‐analysis

Zhang

et al. 2021

Andrologia

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The updated meta‐analysis was conducted to further verify the effect of varicocele on sperm DNA damage, supplying clinicians and researchers with high‐grade evidence. The sperm DNA damage was evaluated by DNA fragmentation index (DFI), associated with the male fertility capability tightly. PubMed, Web of Science and Cochrane Library were searched extensively for eligible studies with the search terms: varicocele, sperm DNA and sperm DNA damage. Finally, a total of 12 studies were included in our meta‐analysis with a total of 845 patients diagnosed with varicocele and 2,377 healthy controls. A statistical difference of DFI between varicocele patients and healthy controls was found after pooling the data ((Standardised mean difference) SMD: 1.40, 95%CI: 0.83–1.98, p < .0001), using the random effect model. We conducted subgroup analysis according to study region (Brazil and Other countries), detection methods of DFI (TUNEL, Comet, and SCSA), sample size (<50 and >50) and age (<30 and >30 years), based on substantial heterogeneity among eligible studies. The stability of pooled results was verified by sensitivity analysis. All these statistical analyses were conducted using Stata version 16.0. In conclusion, patients diagnosed with clinical varicocele had higher DFI than healthy controls, which means varicocele could impair sperm DNA, consequently the fertility potential of affected men.

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“…The prevalence has been reported as up to 80%, and differences in detection rates are the result of differences in diagnostic approach (16,17). Moreover, bilateral varicocelectomy is superior to unilateral in terms of the main outcome of pregnancy rates (9,18). Furthermore, the possible common pathophysiological background (BSV and asthenospermia) and similar expectations (no fertility issues and no desire for fatherhood at that time) formed a homogenous group which gives reproducibility to our results.…”

Section: Discussionmentioning

confidence: 99%

“…Observation, surgical treatment, embolization and empirical treatment with clomiphene citrate or bioflavonoids has been proposed as possible management options (6)(7)(8). A special subgroup of infertile patients with right-sided subclinical and a simultaneous left-sided clinical varicocele seem to have a greater benefit from bilateral intervention in terms of improvement in semen quality and pregnancy rates in comparison to unilateral correction, implicating that the right subclinical varicocele is significant (9). In a similar clinical context, the presence of bilateral subclinical varicocele (BSV) seems to represent a distinct entity with noteworthy clinical significance.…”

Section: Introductionmentioning

confidence: 99%

Role of total motile sperm count in the evaluation of young men with bilateral subclinical varicocele and asthenospermia

Tsampoukas

Dellis

Katsouri

et al. 2020

Arch Ital Urol Androl

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Introduction: In comparison to its clinical analogue, the subclinical varicocele represents a questionable entity and specific guidelines for the optimal management are lacking. In our previous study of patients with subclinical varicocele, we showed that bilateral condition is associated with risk of dyspermia. In the present study, we evaluated the risk of deterioration of semen quality in men with bilateral disease and impaired motility according to WHO criteria. Materials and methods: Men with bilateral subclinical varicocele, not desiring fatherhood at the time of presentation, were included in study. During initial evaluation, the number of Total Motile Sperm Count (TMSC) was calculated and the patients’ age, total testicular volume (TTV), maximum venous size and mean resistive index (RI) of the intratesticular arteries were recorded. We classified the participants in five classes according to the TMSC reading: class A-: TMSC < 5 x 106, class A: TMSC between 5-10 x 106, class B: TMSC between 10-15 x 106, class C: TMSC between 15-20 x 106, and class D: TMSC > 20 x 106 per ejaculate. The participants were seen after 6 months for a repeat spermiogram and physical examination. If clinical varicocele was diagnosed or a new abnormality in the spermiogram was noted, the participants were excluded from the study. The remaining patients were allocated to two groups according to the repeat TMSC reading: patients sub-classified into a lower class (group 1), and patients remaining at the same class (group 2). A comparative analysis was performed between two groups. Results: Nineteen men were included. Nine patients were subclassified (group 1). Three patients moved to A- class (< 5 x 106). Ten patients remained in the same class having no deterioration (group 2). Comparing the two groups, no statistically significant difference was recognized for age, TTV, maximum venous size on both sides, and mean RI (p > 0.05). However, the initial reading for TMSC was 14.57 x 106 in group 1, and 22.84 x 106 in group 2, respectively. This difference was statistically significant (p < 0.05). Additionally, in a paired analysis there was a significant difference in TMSC after 6 months (p < 0.05), too. Summary Conclusions: Young men with bilateral varicocele and asthenospermia seem to be at risk of deterioration in their semen quality after a follow-up of 6 months. The measurement of TMSC can unmask patients at risk, whereas men with the lowest readings seem to be at highest risk for deterioration. The possibility of a worsening sperm quality should be considered in the appropriate clinical context.

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Bilateral is superior to unilateral varicocelectomy in infertile men with bilateral varicocele: Systematic review and meta‐analysis

Cited by 12 publications

References 22 publications

Jiawei Runjing Decoction Improves Spermatogenesis of Cryptozoospermia With Varicocele by Regulating the Testicular Microenvironment: Two-Center Prospective Cohort Study

Jiawei Runjing Decoction Improves Spermatogenesis of Cryptozoospermia With Varicocele by Regulating the Testicular Microenvironment: Two-Center Prospective Cohort Study

Effect of varicocele on sperm DNA damage: A systematic review and meta‐analysis

Role of total motile sperm count in the evaluation of young men with bilateral subclinical varicocele and asthenospermia

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