Open non‐microsurgical, laparoscopic or open microsurgical varicocelectomy for male infertility: a meta‐analysis of randomized controlled trials

Abstract

Study Type – Therapy (systematic review) Level of Evidence 1a What's known on the subject? and What does the study add? There are several surgical techniques for the treatment of varicocele in infertile men, including open non‐microsurgical, laparoscopic and microsurgical varicocelectomy. It is currently unclear, however, which is the most beneficial method for patients. The present meta‐analysis found that microsurgical varicocelectomy is the most effective and least morbid method among the three varicocelectomy techniques for treating varicocele in infertile men. OBJECTIVE To compare various techniques of open non‐microsurgical, laparoscopic or microsurgical varicocelectomy procedures to describe the best method for treating varicocele in infertile men. PATIENTS AND METHODS We searched PubMed, Embase, the Cochrane Library, the Institute for Scientific Information (ISI) – Science Citation Index and the Chinese Biomedicine Literature Database up to June 2011. Only randomized controlled trials (RCTs) were included in the present study. The outcome measures assessed were pregnancy rate (primary), the incidence of recurrent varicocele, time to return to work, the incidence of postoperative hydrocele and operation duration (secondary). Two authors independently assessed the study quality and extracted data. All data were analysed using Review Manager (version 5.0). RESULTS The present study included four randomized controlled trials comprising 1,015 patients in total. At the follow‐up endpoints, patients who had undergone microsurgery showed a significant advantage over those who had undergone open varicocelectomy in terms of pregnancy rate (odds ratio [OR]= 1.63, 95% confidence interval [CI]: 1.19–2.23]. There was no significant difference between laparoscopic and open varicocelectomy (OR = 1.11, 95% CI: 0.65–1.88) or between microsurgery and laparoscopic varicocelectomy (OR = 1.37, 95% CI: 0.84–2.24). The incidences of recurrent varicocele and postoperative hydrocele were significantly lower after microsurgery than after laparoscopic or open varicocelectomy. The time to return to work after microsurgery and laparoscopic varicocelectomy was significantly shorter than that after open varicocelectomy. The operation duration of microsurgical varicocelectomy was longer than that of laparoscopic or open varicocelectomy. CONCLUSIONS Current evidence indicates that microsurgical varicocelectomy is the most effective and least morbid method among the three varicocelectomy techniques for treating varicocele in infertile men. More high‐quality, multicentre, long‐term RCTs are required to verify the findings.

Comparative Analysis of Methods of Surgical Treatment of Varicocele

“…В данный обзор не вхо-дили мужчины с азооспермией, ранее получавших оперативное лечение по поводу варикоцеле. Также в данный обзор не входили исследования мужчин с субклинической степенью варикоцеле [6,7].…”

“…В 37,69% случаев спонтанная беременность наступила после выполнения опе-ративного лечения варикоцеле по методу Palomo, в 30,7% -при выполнении лапароскопической ва-рикоцелэктомии, в 33,2% -при селективной эмбо-лизации сперматических вен и в 36% всех случаев после выполнения операции Иваниссевича. При этом стоит отметить, что выявлены статистически достоверные отличия между используемыми тех-никами оперативного лечения варикоцеле (р = 0,001) [7,11,12].…”

“…Так общий процент рецидивов заболевания пос-ле выполнения операции Palomo составил 14,97%, а после микрохирургической субингвинальной ва-рикоцелэктомии -1,05%, 4,3% -после выполнения лапароскопической варокоцелэктомии, 12,7% -при применении селективной эмболизации сперма-тических вен и 2,63% -при выполнении операции Иваниссевича (р = 0,001) [7,13,14].…”

“…При этом общий процент возникновения в пос-леоперационном периоде таких осложнений, как гидроцеле после выполнения операции Palomo, составил 8,24%, 0,44% -при микрохирургичес-кой субингвинальной варикоцелэктомии, 2,84% -при лапароскопической варикоцелэктомии и 7,3% -после выполнения операции Иваниссевича (р = 0,001) [7,8,9]. В табл.…”

Robotic assisted andrological surgery

“…35,36 Several papers confirmed that the subinguinal microscopic varicocelectomy has superior outcomes to other techniques, such as inguinal or intra-abdominal approaches. [37][38][39] In 2008, Shu et al 8 described the RAVx and compared it with pure microsurgical varicocelectomy. They found that there was no significant difference in terms of operative duration between the groups (even with their initial robotic learning curve).…”