Abstract

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.

Links

Publisher Full Text

Authors

Ding H, Tian J, Du W, Zhang L, Wang H, Wang Z

Institution

Department of Urology, Key Laboratory of Diseases of Urological System, The Second Hospital of Lanzhou University, Gansu, China.

Source

BJU international 110:10 2012 Nov pg 1536-42

MeSH

Humans
Infertility, Male
Laparoscopy
Male
Microsurgery
Postoperative Complications
Randomized Controlled Trials as Topic
Recurrence
Return to Work
Varicocele

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

22642226