Do sclero-embolization procedures have advantages over surgical ligature in treating varicocele in children, adolescents and adults? Results from a systematic review and meta-analysis.
adults
children
postoperative complications
pregnancy
varicocele
Journal
Andrologia
ISSN: 1439-0272
Titre abrégé: Andrologia
Pays: Germany
ID NLM: 0423506
Informations de publication
Date de publication:
Sep 2022
Sep 2022
Historique:
revised:
13
06
2022
received:
10
05
2022
accepted:
15
06
2022
pubmed:
25
6
2022
medline:
4
8
2022
entrez:
24
6
2022
Statut:
ppublish
Résumé
We aimed to systematically review complications, and recurrence rate of varicocele treatment by comparing the surgical ligature versus sclero-embolization techniques in children, adolescents and adults. The secondary outcomes were the evaluation of semen parameters and spontaneous pregnancy rate in adults. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Continuous variables were pooled using the inverse variance of the mean difference (MD) with a fixed effect, and 95% confidence interval (CI). The incidences of complications were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and reported as Odds Ratio (OR), and 95% CI. Statistical significance was set two-tail p-value < 0.05. Twenty studies were included. Incidence of postoperative hydrocele was significantly higher in the surgical ligation group (OR 3.06 95% CI 1.06-8.88, p = 0.04). Incidence of postoperative orchiepidydimitys was significantly higher in sclero-embolization group (OR 0.26 95% CI 0.08-0.85, p = 0.02). Presence of normal spermatozoa was significantly higher sclero-embolization group compared with the surgical ligature group (MD 2.54% 95% CI 0.43-4.65, p = 0.02). No difference was found in overall complications, wound infection, testis pain, surgical site hematoma, total sperm count, sperm motility, pregnancy and recurrence rate. This review confirms that current data does still not support the superiority of one type of treatment over other ones.
Types de publication
Journal Article
Meta-Analysis
Review
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
e14510Informations de copyright
© 2022 Wiley-VCH GmbH.
Références
Baazeem, A., Belzile, E., Ciampi, A., Dohle, G., Jarvi, K., Salonia, A., Weidner, W., & Zini, A. (2011). Varicocele and male factor infertility treatment: A new meta-analysis and review of the role of varicocele repair. European Urology, 60(4), 796-808.
Bechara, C. F., Weakley, S. M., Kougias, P., Athamneh, H., Duffy, P., Khera, M., Kobayashi, K., & Lin, P. H. (2009). Percutaneous treatment of varicocele with microcoil embolization: Comparison of treatment outcome with laparoscopic varicocelectomy. Vascular, 17(Suppl 3), S129-S136.
Beutner, S., May, M., Hoschke, B., Helke, C., Lein, M., Roigas, J., & Johannsen, M. (2007). Treatment of varicocele with reference to age: A retrospective comparison of three minimally invasive procedures. Surgical Endoscopy, 21(1), 61-65.
Bolla, G. (2014). Why open surgery for treatment of paediatric varicocele? La Pediatria Medica e Chirurgica: Medical and Surgical Pediatrics, 36(4), 89.
Cannarella, R., Calogero, A. E., Condorelli, R. A., Giacone, F., Aversa, A., & La Vignera, S. (2019). Management and treatment of varicocele in children and adolescents: An endocrinologic perspective. Journal of Clinical Medicine, 8(9), 1410.
Çayan, S., Orhan, İ., Akbay, E., & Kadıoğlu, A. (2019). Systematic review of treatment methods for recurrent varicoceles to compare post-treatment sperm parameters, pregnancy and complication rates. Andrologia, 51(11), e13419.
Dewire, D. M., Jr Thomas, A. J., Falk, R. M., Geisinger, M. A., & Lammert, G. K. (1994). Clinical outcome and cost comparison of percutaneous embolization and surgical ligation of varicocele. Journal of Andrology, 15(Suppl), 38S-42S.
Ding, H., Tian, J., Wan, D., Zhang, L., Wang, H., & Wang, Z. (2012). Open non-microsurgical, laparoscopic or open microsurgical varicocelectomy for male infertility: A meta-analysis of randomized controlled trials. BJU International, 110(10), 1536-1542.
Feneley, M. R., Pal, M. K., Nockler, I. B., & Hendry, W. F. (1997). Retrograde embolization and causes of failure in the primary treatment of varicocele. British Journal of Urology, 80(4), 642-646.
Halpern, J., Mittal, S., Pereira, K., Bhatia, S., & Ramasamy, R. (2016). Percutaneous embolization of varicocele: Technique, indications, relative contraindications, and complications. Asian Journal of Andrology, 18(2), 234-238.
Higgins, J. P. T., Altman, D. G., Gøtzsche, P. C., Jüni, P., Moher, D., Oxman, A. D., Savovic, J., Schulz, K. F., Weeks, L., & Sterne, J. A. C. (2011). The Cochrane collaboration's tool for assessing risk of bias in randomised trials. British Medical Journal (Clinical Research Ed.), 343, d5928.
Jacobson, D. L., & Johnson, E. K. (2017). Varicoceles in the pediatric and adolescent population: Threat to future fertility? Fertility and Sterility, 108(3), 370-377.
Jensen, C. F. S., Østergren, P., Dupree, J. M., Ohl, D. A., Sønksen, J., & Fode, M. (2017). Varicocele and male infertility. Nature Reviews. Urology, 14(9), 523-533.
Jing, Y. X., Wang, R. H., Liu, Z. X., & Meng, Q. Y. (2020). Analysis of internal spermatic vein embolization through catheter versus laparoscopic high ligation in treatment of left varicocele. Vascular, 28(5), 583-590.
Johnson, D., & Sandlow, J. (2017). Treatment of varicoceles: Techniques and outcomes. Fertility and Sterility, 108(3), 378-384.
Kohn, T. P., Kohn, J. R., & Pastuszak, A. W. (2017). Varicocelectomy before assisted reproductive technology: Are outcomes improved? Fertility and Sterility, 108(3), 385-391.
Kovac, J. R., Fantus, J., Lipshultz, L. I., Fischer, M. A., & Klinghoffer, Z. (2014). Cost-effectiveness analysis reveals microsurgical varicocele repair is superior to percutaneous embolization in the treatment of male infertility. Canadian Urological Association Journal, 8(9-10), E619-E625.
Mazzoni, G., Fiocca, G., Minucci, S., Pieri, S., Paolicelli, D., Morucci, M., Bibbolino, C., De Medici, L., & Calisti, A. (1999). Varicocele: A multidisciplinary approach in children and adolescents. The Journal of Urology, 162(5), 1755-1758.
Mazzoni, G., Spagnoli, A., Lucchetti, M. C., Villa, M., Capitanucci, M. L., & Ferro, F. (2001). Adolescent varicocele: Tauber antegrade sclerotherapy versus palomo repair. The Journal of Urology, 166(4), 1462-1464.
Mongioì, L. M., Mammino, L., Compagnone, M., Condorelli, R. A., Basile, A., Alamo, A., La Vignera, S., Morgia, G., Russo, G. I., & Calogero, A. E. (2019). Effects of varicocele treatment on sperm conventional parameters: Surgical varicocelectomy versus sclerotherapy. Cardiovascular and Interventional Radiology, 42(3), 396-404.
Motta, A., Caltabiano, G., Pizzarelli, M., Failla, G., Botezatu, D., Muresanu, H., Foti, P., La Vignera, S., Condorelli, R., Palmucci, S., & Basile, A. (2019). Varicocele, conventional laparoscopic ligation versus occluding balloon embolization. Radiologia Medica, 124(5), 438-443.
Nasr, B., Elie, M. B., Almont, T., Rischmann, P., Soulie, M., & Huyghe, E. (Eds.). (2017). Subinguinal microsurgical varicocelectomy vs. percutaneous embolization in infertile men: Prospective comparison of reproductive and functional outcomes. Basic and Clinical Andrology, 27, 11.
Nasser, H. M., Hussein, A., Behairy, G. M., & Abdo, M. (2020). Impact of percutaneous embolization versus subinguinal microsurgical ligation on semen parameters in primary varicocele patients: comparative study. Egyptian Journal of Radiology and Nuclear Medicine, 51(1), 249.
Nieschlag, E., Behre, H. M., Schlingheider, A., Nashan, D., Pohl, J., & Fischedick, A. R. (1993). Surgical ligation vs. angiographic embolization of the vena spermatica: A prospective randomized study for the treatment of varicocele-related infertility. Andrologia, 25(5), 233-237.
Parsch, E. M., Schill, W. B., Erlinger, C., Tauber, R., & Pfeifer, K. J. (1990). Semen parameters and conception rates after surgical treatment and sclerotherapy of varicocele. Andrologia, 22(3), 275-278.
Persad, E., O'Loughlin, C. A., Kaur, S., Wagner, G., Matyas, N., Fratta, M. R. H.-D., & Nussbaumer-Streit, B. (2021). Surgical or radiological treatment for varicoceles in subfertile men. The Cochrane Database of Systematic Reviews, 4(4), CD000479.
Robinson, S. P., Hampton, L. J., & Koo, H. P. (2010). Treatment strategy for the adolescent varicocele. The Urologic Clinics of North America, 37(2), 269-278.
Sayfan, J., Soffer, Y., & Orda, R. (1992). Varicocele treatment: Prospective randomized trial of 3 methods. The Journal of Urology, 148(5), 1447-1449.
Schoor, R. A., Elhanbly, S. M., & Niederberger, C. (2001). The pathophysiology of varicocele-associated male infertility. Current Urology Reports, 2(6), 432-436.
Sepúlveda, L., Coimbra, D., Lourenço, M., Santos, L., Oliveira, C., Coutinho, S., & Ramos, M. (2018). Varicocele treatment in patients up to 35 years old: A multicentric retrospective studycomparing 3 different techniques. Archivos Españoles de Urología, 71(6), 543-548.
Shlansky-Goldberg, R. D., VanArsdalen, K. N., Rutter, C. M., Soulen, M. C., Haskal, Z. J., Baum, R. A., Redd, D. C., Cope, C., & Pentecost, M. J. (1997). Percutaneous varicocele embolization versus surgical ligation for the treatment of infertility: Changes in seminal parameters and pregnancy outcomes. Journal of Vascular and Interventional Radiology, 8(5), 759-767.
Sterne, J. A., Hernán, M. A., Reeves, B. C., Savović, J., Berkman, N. D., Viswanathan, M., Henry, D., Altman, D. G., Ansari, M. T., Boutron, I., Carpenter, J. R., Chan, A.-W., Churchill, R., Deeks, J. J., Hróbjartsson, A., Kirkham, J., Jüni, P., Loke, Y. K., Pigott, T. D., … Higgins, J. P. (2016). ROBINS-I: A tool for assessing risk of bias in non-randomised studies of interventions. BMJ, 355, i4919.
Su, J. S., Farber, N. J., & Vij, S. C. (2021). Pathophysiology and treatment options of varicocele: An overview. Andrologia, 53(1), e13576.
Vakalopoulos, I., Kampantais, S., Lymperi, S., Grivas, N., Ioannidis, A., Mykoniatis, I., Nikolaou, V., & Dimitriadis, G. (2017). Should we expand the indications for varicocele treatment? Translational Andrology and Urology, 6(5), 931-942.
Wickham, A., Dan, V., El-Arabi, A., & Gatti, J. M. (2021). Adolescent varicocelectomy: Success at what cost? Clinical outcome and cost comparison of surgical ligation and percutaneous embolization. Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A, 31(8), 942-946.
Yavetz, H., Levy, R., Papo, J., Yogev, L., Paz, G., Jaffa, A. J., & Homonnai, Z. T. (1992). Efficacy of varicocele embolization versus ligation of the left internal spermatic vein for improvement of sperm quality. International Journal of Andrology, 15(4), 338-344.
Zucchi, A., Mearini, L., Mearini, E., Costantini, E., Bini, V., & Porena, M. (2005). Treatment of varicocele: Randomized prospective study on open surgery versus tauber antegrade sclerotherapy. Journal of Andrology, 26(3), 328-332.
Zucchi, A., Mearini, L., Mearini, E., Fioretti, F., Bini, V., & Porena, M. (2006). Varicocele and fertility: Relationship between testicular volume and seminal parameters before and after treatment. Journal of Andrology, 27(4), 548-551.