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

Dilated testicular gubernacular veins after varicocelectomy were reported to be the cause of varicocele recurrence. The gubernacular veins start at the tail of the testicular and merges into the posterior scrotal veins. The gubernacular veins could be ligated only after testicular delivery (TD) anatomically. TD and ligation of the gubernacular veins during microsurgical varicocelectomy might reduce the varicocele recurrence but this method is still under debate. Therefore, we performed this systematic review and meta-analysis and assessed varicocele recurrence, complications as well as clinical outcomes after microsurgical varicocelectomy with TD. Relevant researches were searched on the PubMed, Embase, Cochrane Library, Web of Science, and China National Knowledge Infrastructure databases to perform an updated meta-analysis. Standardized mean differences, relative risks (RRs), and their 95% confidence intervals (CIs) were applied to evaluate result indicators. This updated meta-analysis included 17 publications with 10 randomized controlled trials and 7 cohort studies. A total of 2,254 participants, including 1,024 subjects with TD and 1,230 without TD, were involved. The pooled results demonstrated that microsurgical varicocelectomy with TD might lead to higher incidences of postoperative scrotal edema (RR = 4.20, 95% CI = 2.60–6.81, p < 0.001 ), testicular hydrocele (RR = 6.58, 95% CI = 1.19–36.20, p = 0.030 ), and orchiepididymitis (RR = 6.33, 95% CI = 2.08–19.31, p = 0.001 ) than the group without TD. Similar findings were also found in subgroup analysis of varicocele grade II and III. By contrast, we failed to find significant differences between them in semen parameters, varicocele recurrence, serum testosterone, and natural pregnancy ( p > 0.05 ). Sensitivity analysis revealed the pooled results were stable and no publication bias was detected. TD during microsurgical varicocelectomy may lead to more postoperative complications and may not be beneficial for semen parameters, recurrence of varicocele, and natural pregnancy. Therefore, varicocele patients may not benefit more from TD.

show abstract

Does Varicocele Repair Improve Conventional Semen Parameters? A Meta-Analytic Study of Before-After Data

Cannarella

Shah

Hamoda

et al. 2024

World J Mens Health

View full text Add to dashboard Cite

Purpose The purpose of this meta-analysis is to study the impact of varicocele repair in the largest cohort of infertile males with clinical varicocele by including all available studies, with no language restrictions, comparing intra-person conventional semen parameters before and after the repair of varicoceles. Materials and Methods The meta-analysis was performed according to PRISMA-P and MOOSE guidelines. A systematic search was performed in Scopus, PubMed, Cochrane, and Embase databases. Eligible studies were selected according to the PICOS model (Population: infertile male patients with clinical varicocele; Intervention: varicocele repair; Comparison: intra-person before-after varicocele repair; Outcome: conventional semen parameters; Study type: randomized controlled trials [RCTs], observational and case-control studies). Results Out of 1,632 screened abstracts, 351 articles (23 RCTs, 292 observational, and 36 case-control studies) were included in the quantitative analysis. The before-and-after analysis showed significant improvements in all semen parameters after varicocele repair (except sperm vitality); semen volume: standardized mean difference (SMD) 0.203, 95% CI: 0.129–0.278; p<0.001; I 2 =83.62%, Egger’s p=0.3329; sperm concentration: SMD 1.590, 95% CI: 1.474–1.706; p<0.001; I 2 =97.86%, Egger’s p<0.0001; total sperm count: SMD 1.824, 95% CI: 1.526–2.121; p<0.001; I 2 =97.88%, Egger’s p=0.0063; total motile sperm count: SMD 1.643, 95% CI: 1.318–1.968; p<0.001; I 2 =98.65%, Egger’s p=0.0003; progressive sperm motility: SMD 1.845, 95% CI: 1.537%–2.153%; p<0.001; I 2 =98.97%, Egger’s p<0.0001; total sperm motility: SMD 1.613, 95% CI 1.467%–1.759%; p<0.001; l2=97.98%, Egger’s p<0.001; sperm morphology: SMD 1.066, 95% CI 0.992%–1.211%; p<0.001; I 2 =97.87%, Egger’s p=0.1864. Conclusions The current meta-analysis is the largest to date using paired analysis on varicocele patients. In the current meta-analysis, almost all conventional semen parameters improved significantly following varicocele repair in infertile patients with clinical varicocele.

show abstract

scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.

Contact Info

hi@scite.ai

10624 S. Eastern Ave., Ste. A-614

Henderson, NV 89052, USA

Blog Terms and Conditions API Terms Privacy Policy Contact Cookie Preferences Do Not Sell or Share My Personal Information

Made with 💙 for researchers

Part of the Research Solutions Family.

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

Cited by 3 publications

References 19 publications

Impact of testicular delivery and vasal vein ligation on clinical outcomes in men undergoing microsurgical varicocelectomy

Impact of testicular delivery and vasal vein ligation on clinical outcomes in men undergoing microsurgical varicocelectomy

Comparison between Microsurgical Varicocelectomy with and without Testicular Delivery for Treatment of Varicocele: An Updated Systematic Review and Meta-Analysis

Does Varicocele Repair Improve Conventional Semen Parameters? A Meta-Analytic Study of Before-After Data

Contact Info

Product

Resources

About