Do sclero‐embolization procedures have advantages over surgical ligature in treating varicocele in children, adolescents and adults? Results from a systematic review and meta‐analysis

Abstract

We aimed to systematically review complications, and recurrence rate of varicocele treatment by comparing the surgical ligature versus sclero-embolization techniques in children, adolescents and adults. The secondary outcomes were the evaluation of semen parameters and spontaneous pregnancy rate in adults. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Continuous variables were pooled using the inverse variance of the mean difference (MD) with a fixed effect, and 95% confidence interval (CI). The incidences of complications were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and reported as Odds Ratio (OR), and 95% CI. Statistical significance was set two-tail p-value < 0.05. Twenty studies were included. Incidence of postoperative hydrocele was significantly higher in the surgical ligation group (OR 3.06 95% CI 1.06-8.88, p = 0.04). Incidence of postoperative orchiepidydimitys was significantly higher in sclero-embolization group (OR 0.26 95% CI 0.08-0.85, p = 0.02). Presence of normal spermatozoa was significantly higher sclero-embolization group compared with the surgical ligature group (MD 2.54% 95% CI 0.43-4.65, p = 0.02). No difference was found in overall complications, wound infection, testis pain, surgical site hematoma, total sperm count, sperm motility, pregnancy and recurrence rate. This review confirms that current data does still not support the superiority of one type of treatment over other ones.

A cost outcome study of varicocoele embolisation and future pregnancy in an Australian public hospital setting

“…Of these, six studies assessed pregnancy after embolisation and the meta‐analysis showed successful pregnancy in 91 of 222 patients at a rate of 40.99%. The rate was similar between surgical repair and embolisation (40.99% vs. 41.58%, OR 1.03, P = 0.97) 2 …”

“…To calculate cost per pregnancy, costs were adjusted according to existing published data on the rate of pregnancy after varicocoele embolisation. The authors chose to use the highest quality data at the time of publishing as thus used results of the recent meta-analysis published by Fabiani et al 2 In this study, the authors showed pregnancy after embolisation in 91 of 222 patients, a rate of 0.4099. As such, we calculated the cost per pregnancy as the median total cost divided by the published pregnancy rate.…”

“…Varicocoele is a common problem afflicting approximately 15% of males and is characterised by dilatation of the gonadal vein, leading to dilated pampiniform plexus and abnormal venous drainage from the testicle. 1,2 They most commonly occur on the left due to variations in the length of spermatic veins, valvular incompetence, varying angle of insertion of the left gonadal vein to the left renal vein, and can also occur due to extrinsic compression of the left renal vein by the overlying superior mesenteric artery. 3 Varicocoele may cause symptoms such as pain or discomfort.…”

“…The rate was similar between surgical repair and embolisation (40.99% vs. 41.58%, OR 1.03, P = 0.97). 2 The aim of our study was to assess the cost of varicocoele embolisation at our institution, and to estimate the treatment cost per pregnancy using the highest level of published pregnancy data.…”

“…EUR€3207 †Based on published pregnancy rates after embolisation from the systematic review of Fabiani et al2 calculated to be AUD$5387 (USD$3429 or EUR€3207). As a public hospital with remuneration of outpatient services via the federal government through the Medicare Benefits Schedule, and inpatient remuneration via the state government through activity-based funding, the total cost to the patient per pregnancy was $0.…”