• Logo
  • SBMUJournals

Efficacy and Safety of Microsurgical Subinguinal Varicocelectomy with and without Testicular Delivery for Varicocele Patients: A Systematic Review and Meta-Analysis

Bo Liao, Junbo Liu, Shuangquan Chen, Qiang Zhang, Chaofan Xie, Guo Jiang, Shu Cui, Tao Wu
238

Views


Abstract

Purpose: This study reviewed the efficacy and safety of the microsurgical subinguinal varicocelectomy (MSV) with and without testicular delivery (TD) for varicocele patients.

Materials and Methods: A systematic literature search was conducted in EMBASE, PubMed, MEDLINE, Cochrane databases, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), and Google Scholar databases to identify relevant studies that reported MSV with and without TD for varicocele patients published in English or Chinese up to October 2018. The Newcastle-Ottawa Scale (NOS) and the Jadad scores were used to evaluate the methodological quality of all the included studies. We also used the Cochrane Collaboration’s tool for assessing risk of bias for each study. The Review Manager Software version 5.3 was used to conduct data analysis.

Results: Four RCTs and three retrospective studies consisting of 993 patients were included. Meta-analysis results indicated that both of the two treatments were effective and safe. MSV with TD had a lower recurrence rate (OR = 0.20, 95% CI: 0.06 - 0.65, P = .007, I2 = 0%) and postoperative serum testosterone level (MD = -39.07, 95% CI: -51.95 - -26.18, P = .00001, I2 = 0%) compared with MSV without TD but was associated with higher postopera­tive complications rate (OR=7.35, 95% CI: 2.92-18.53, P < .0001, I2 = 0%). We found no significant differences in operation time (MD = 12.46, 95% CI:0.11-24.81,P= .05, I2 = 87%), sperm concentration (MD = 3.73, 95% CI: -2.88 - 10.35, P = .27, I2 = 81%), sperm motility (MD = 10.96, 95% CI: -11.93 - 33.86, P = .35, I2 = 99%), and pregnancy rate(OR = 0.65, 95% CI: 0.37- 1.16, P = .15, I2 = 0%).

Conclusion: This meta-analysis compared efficacy and safety of MSV with and without TD for varicocele pa­tients. MSV with TD was associated with a higher postoperative complication rate but lower recurrence rate and postoperative serum testosterone level than MSV without TD. In terms of preoperative serum testosterone level, operation time, sperm concentration, sperm motility, and pregnancy rate, we found no significant differences.


References

Gorelick JI, Goldstein M. Loss of fertility in men with varicocele. Fertil Steril 1993; 59: 613-616.

Saypol DC. Varicocele. J Androl 1981; 2: 61-71.

Jarow JP. Effects of varicocele on male fertility. Hum Reprod Update 2001; 7: 59-64.

Goldstein M. New insights into the etiology and treatment of infertility. J Urol 1997; 158(5): 1808-1809.

Daitch JA, Bedaiwy MA, Pasqualotto EB, N HB, J H, T F et al. Varicocelectomy improves intrauterine insemination success rates in men with varicocele. The Journal of urology 2001; 165(5): 1510-1513.

Baazeem A, Belzile E, Ciampi A, Dohle G, Jarvi K, Salonia A et al. Varicocele and male factor infertility treatment: a new meta-analysis and review of the role of varicocele repair. European urology 2011; 60(4): 796-808.

Schlegel PN. Is assisted reproduction the optimal treatment for varicocele-associated male infertility? A cost-effectiveness analysis. Urology 1997; 49(1): 83-90.

Cayan S, Shavakhabov S, Kadioglu A. Treatment of palpable varicocele in infertile men: a meta-analysis to define the best technique. J Androl 2009; 30(1): 33-40.

Wu T, Duan X, Yang X, Deng X, Cui S. Laparoendoscopic single-site varicocelectomy compared with conventional laparoscopic surgery: a systematic review and meta-analysis. Springerplus 2016; 5(1): 1483.

Nie H, Gao Q, Chen L, Wang S. Comparative analysis of three kinds of varicocelectomy surgical approaches. The Chinese Journal of Human Sexuality 2017; 26(3): 24-27.

Ding H, Tian J, Du W, Zhang L, Wang H, Wang Z. Open non-microsurgical, laparoscopic or open microsurgical varicocelectomy for male infertility:A meta-analysis of randomized controlled trials. BJU Int 2012; 110(10): 1536-1542.

Yang Y, Huang W, Cao J, Wu H, Cao M, Zhang Y et al. Microsurgical subinguinal varicocelectomy with delivery of the testis and ligation of gubernacular veins: Evaluation of clinical effects. National Journal of Andrology 2018; 24(3): 226-230.

Nourparvar P, Herrel L, Hsiao W. Microsurgical subinguinal varicocelectomy with testicular delivery. Fertil Steril 2013; 100(6): e42.

Kim SO, Chung HS, Park K. Modified microsurgical subinguinal varicocelectomy without testicular delivery. Andrologia 2011; 43: 405-408.

Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 2009; 62(10): 1006-1012.

Phillips B, Ball C, Sackett D. Oxford Centre for Evidence-based Medicine—levels of evidence. Centre for Evidence-Based Medicine Web site: http://wwwcebmnet/indexaspx?o=1025 2009.

Wells G, Shea B, O’connell D, Peterson J, Welch V, Losos M et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analysis.Ottawa Health Research Institute web site. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm. 2011.

Clark HD, Wells GA, Huet C, McAlister FA, Salmi LR, Fergusson D et al. Assessing the quality of randomized trials: reliability of the Jadad scale. Controlled clinical trials 1999; 20(5): 448-452.

Ramasamy R, Schlegel PN. Microsurgical inguinal varicocelectomy with and without testicular delivery. Urology 2006; 68(6): 1323-1326.

Hou Y, Zhang Y, Zhang Y, Huo W, Li H. Comparison between Microsurgical Subinguinal Varicocelectomy with and without Testicular Delivery for Infertile Men: Is Testicular Delivery an Unnecessary Procedure. Urol J 2015; 12:: 2261-2266.

Spinelli C, Strambi S, Busetto M, Rossi L, Piscioneri J, Pucci A et al. Microsurgical inguinal varicocelectomy in adolescents: delivered versus not delivered testis procedure. The Canadian Journal of Urology 2016; 23(2): 8254-8259.

Choi CI, Park KC, Lee TH, Hong YK. Recurrence rates in pediatric patients undergoing microsurgical subinguinal varicocelectomy with and without testicular delivery. J Pediatr Surg 2017; 52(9): 1507-1510.

Allameh F, Hasanzadeh Haddad A, Abedi A, Ranjbar A, Qashqai H, Fadavi B et al. Varicocelectomy with primary gubernaculum veins closure: A randomised clinical trial. Andrologia 2018.

Romeo C, Santoro G. Varicocele and infertility: why a prevention? J Endocrinol Invest 2009; 32(6): 559-561.

Miyaoka R, Esteves SC. A Critical Appraisal on the Role of Varicocele in Male Infertility. Adv Urol 2012: 597495.

Yuan R, Zhuo H, Cao D, Wei Q. Efficacy and safety of varicocelectomies: A meta-analysis. Syst Biol Reprod Med 2017; 63(2): 120-129.

Borruto FA, Impellizzeri P, Antonuccio P, Finocchiaro A, Scalfari G, Arena F et al. Laparoscopic vs open varicocelectomy in children and adolescents: review of the recent literature and meta-analysis. J Pediatr Surg 2010; 45(12): 2464-2469.

Al-Kandari AM, Shabaan H, Ibrahim HM, Elshebiny YH, Shokeir AA. Comparison of outcomes of different varicocelectomy techniques: open inguinal, laparoscopic, and subinguinal microscopic varicocelectomy: a randomized clinical trial. Urology 2007; 69(3): 417-420.

Watanabe M, Nagai A, Kusumi N, Tsuboi H, Nasu Y, Kumon H. Minimal invasiveness and effectivity of subinguinal microscopic varicocelectomy: a comparative study with retroperitoneal high and laparoscopic approaches. Int J Urol 2005; 12: 892-898.

Chalouhy E, Kassardjian Z, Merhej S, Chaiban R, Moukarzel M, Ezzo G et al. Microsurgical high inguinal varicocelectomy with delivery of the testis. J Med Liban 1994; 42: 105-108.

Yilmaz O, Genc A, Taneli F, Demireli P, Deveci Kocakoc I, Sencan A et al. Long-term effect of pentoxifylline and NG-nitro-L-arginine methyl ester on testicular function in spermatic artery ligation. Scand J Urol Nephrol 2006; 40(1): 12-16.

Guler F, Bingol-Kologlu M, Yagmurlu A, Guven C, Hasirci N, Kuc O et al. The effects of local and sustained release of fibroblast growth factor on testicular blood flow and morphology in spermatic artery-and vein-ligated rats. J Pediatr Surg 2004; 39: 709-716.

Agarwal A, Deepinder F, Cocuzza M, Agarwal R, Short RA, Sabanegh E et al. Efficacy of varicocelectomy in improving semen parameters: new meta-analytical approach. Urology 2007; 70(3): 532-538.

Zhang M, Du L, Liu Z, Qi H, Chu Q. The Effects of Varicocelectomy on Testicular Arterial Blood Flow: Laparoscopic Surgery versus Microsurgery. Urol J 2014; 11: 1900-1906.

Will MA, Swain J, Fode M, Sonksen J, Christman GM, Ohl D. The great debate: varicocele treatment and impact on fertility. Fertil Steril 2011; 95(3): 841-852.

Lee JY, Yu HS, Ham WS, Kang DH, Kim KH, Chung DY et al. Microsurgical intermediate subinguinal varicocelectomy. Int Surg 2014; 99(4): 398-403.

Orhan I, Onur R, Semerciöz A, Firdolas F, Ardicoglu A, Köksal IT. Comparison of two different microsurgical methods in the treatment of varicocele. Arch Androl 2005; 51: 213-220.

Cayan S, Kadioglu TC, Tefekli A, Kadioglu A, Tellaloglu S. Comparison of results and complications of high ligation surgery and microsurgical high inguinal varicocelectomy in the treatment of varicocele. Urology 2000; 55: 750-754.

Murray RR, Mitchell SE, Kadir S, Saadoon K, L KS, Richard C et al. Comparison of recurrent varicocele anatomy following surgery and percutaneous balloon occlusion. The Journal of urology 1986; 135: 286-289.

Goldstein M, Gilbert BR, Dicker AP, Dwosh J, Gnecco C. Microsurgical inguinal varicocelectomy with delivery of the testis: an artery and lymphatic sparing technique. The Journal of urology 1992; 148: 1808–1811.

Cho SJ, Kim SC, Kim KS, Park S. Magnification-assisted subinguinal varicocelectomy with testicular delivery in children: a preliminary report. World J Mens Health 2014; 32(2): 93-98.




DOI: http://dx.doi.org/10.22037/uj.v0i0.5095

Refbacks

  • There are currently no refbacks.