Comparison between microsurgical varicocelectomy with and without testicular delivery for treatment of varicocele: A systematic review and meta‐analysis

Abstract

The present study was conducted to assess the semen parameters, complications and clinical effect of microsurgical varicocelectomy with testicular delivery (TD) for treatment of varicocele. Relevant studies were collected and reviewed systemically from PubMed, Medline, Embase, Web of Science, China National Knowledge Infrastructure databases and the Cochrane Library and a meta‐analysis was performed. Relative ratio (RR), standardised mean difference (SMD) and their 95% confidence intervals (CIs) were adopted to estimate the outcome measures. Eight articles and a total of 1,139 subjects including 487 patients with TD in microsurgical varicocelectomy and 652 patients without TD were enrolled in this meta‐analysis. The pooled RR indicated that microsurgical varicocelectomy with TD increased the incidence of orchiepididymitis (RR = 4.36, 95% CI = 1.12–16.99, p = 0.034) and scrotal oedema (RR = 4.25, 95% CI = 2.40–7.54, p = 0.000) than microsurgical varicocelectomy without TD postoperatively. In conclusion, compared to microsurgical varicocelectomy without TD, TD to further ligate the gubernacular veins in microsurgical varicocelectomy results in a higher incidence of orchiepididymitis and scrotal oedema and take longer operation time. However, TD may not have any beneficial influences on semen parameters, serum testosterone, varicocele occurrence, wound infection and natural conception.

Predictive value of haematologic parameters in diagnosis of testicular torsion: Evidence from a systematic review and meta‐analysis

“…A detailed statistical method of meta‐analysis was stated in our previous study (Song, Lu, Xu, Yang, & Liu, ). Weighted mean difference (WMD), standard mean difference (SMD) and their 95% confidence interval (CI) were calculated for outcomes and statistical significance of WMD or SMD was due to the Z test.…”

Evaluation of clinical effects of microsurgical subinguinal varicocelectomy with and without testicular delivery

“…However, Allameh et al (2018) found that MSV with testicular delivery could improve the sperm motility and per cent of normal morphology compared with that without testicular delivery. In a meta‐analysis published recently, it is found that MSV with testicular delivery could increase total sperm count in patients with grade II and III varicocele, while taking no benefits to sperm viability, sperm concentration and progressively motile spermatozoa (Song, Lu, Xu, Yang, & Liu, 2019). And the results also indicated that MSV with testicular delivery caused a higher incidence of orchiepididymitis and scrotaloedema and took longer operation time compared with MSV without.…”

Clinical effectiveness of microsurgical subinguinal varicocelectomy with enhanced recovery after surgery for varicocele

“…Testicular delivery is needed if the gubernacular veins are ligated, which not only requires an enlarged incision (which increases the difficulty of the local anesthesia and the risk of testicular injury) but also may result in impaired venous return and scrotal edema, along with an increased incidence of hydrocele (25,26). A meta-analysis in 2019 revealed that ligation of the gubernacular veins resulted in a higher incidence of orchiepididymitis (RR =4.36; 95% CI: 1.12-16.99; P=0.034) and scrotal oedema (RR =4.25; 95% CI: 2.40-7.54; P<0.001) and showed no beneficial influences on semen parameters or natural conception (27). In addition, whether the gubernacular veins were handled or not did not have any effect on the VC recurrence rate (28).…”