Microsurgical and Varicocelectomy Compersion With and Without Testicular Delivery for Treatment of Varicocele: A Randomize Control Trial

Abstract

Purpose: Varicocele is a common type of male genital disease and can occur in men of any age, especially young people. Clinically venous enlargement or varicocele are found in about 15% of the general male population, up to 35% of men with primary fertility, and 75% of men with secondary fertility dysfunction. Varicoceles are known to be the most common cause of male infertility and can be corrected surgically, but the exact mechanism of sperm formation caused by varicocele-induced impairment remains controversial. Most men with varicocele are asymptomatic and infertile, with only 15% – 20% suffering from physical discomfort or other fertility-related problems. With therefore systematically evaluated the RCTs published together and summarized evidence evaluating the benefits of testicular delivery and ligation of gubernacular vein in microsurgical varicocelectomy.
 Methodology: Comprehensive electronic search using the keywords "microsurgical varicocelectomy", "gubernacular vein", "testicular delivery", "infertility" and "varicocele" was done in databases of Cochrane, PubMed, Embase, CINAHL and Web of Science databases. English language used to search databases. Some studies were taken from studies references.
 Result: Two studies reported grade II and III of varicoceles in patients that participated in the study. Overall sperm count in microsurgical resection with testicular delivery compared to microsurgical resection without testicular delivery, increased significantly (SMD = 0.23, 95% CI = 0.07-0.39, p =<.05), but sperm motility, sperm concentration and gradual increase have no difference in between the two microsurgical methods (p> 0.05).
 Conclusion: In conclusion, as a result of this systematic review and meta-analysis, compared with microsurgical varicocelectomy without testicular delivery, delivery of the testicles during microsurgical varicocelectomy to further to further ligate the gonadal veins leads to epidydemo orchitis and oedema, and longer surgery. In addition, testicular delivery may not improve parameters of sperm, serum testosterone, and incidence of varicose veins, wound inflammation and spontaneous pregnancy compared to non-delivered testicles. However, a higher level of research is needed to determine if testicular delivery is an important surgery in microsurgical venous ligation.