The objective of the present systematic review and meta-analysis was to assess the effect of open, microsurgical, and laparoscopic varicocelectomy on the number of patients with improved sperm parameters (sperm concentration, motility) 6–12 months after surgery, spontaneous pregnancy rates ≥ 12 months after surgery, and postoperative sperm parameters in infertile males with a varicocele. We searched the Cochrane Library, PubMed, MEDLINE, and EMBASE databases from inception to December 2018 for randomized controlled trials (RCTs) comparing open, microsurgical, and laparoscopic varicocelectomy for male infertility. The meta-analysis demonstrated a significantly higher number of patients with improved sperm parameters 6–12 months after microsurgical varicocelectomy compared to laparoscopic varicocelectomy (OR = 1.63, 95% CI 1.03–2.56; p = 0.04) or open varicocelectomy (OR = 2.06, 95% CI 1.57–2.70; p < 0.0001), a significantly higher spontaneous pregnancy rate at ≥ 12 months after microsurgical varicocelectomy compared to open varicocelectomy (OR = 1.47, 95% CI 1.10–1.98; p = 0.01), a significant increase in postoperative sperm motility and concentration in patients that had undergone microsurgical varicocelectomy compared to laproscopic varicocelectomy or open varicocelectomy. These data suggest that, compared to laproscopic or open varicocelectomy, microsurgical varicocelectomy provides the greatest benefit to the most patients, results in a higher spontaneous pregnancy rate, and causes greater improvements in postoperative sperm parameters in males with a history of infertility. More high-quality large studies are needed to better illustrate the effects of the various surgical methods used to treat varicocele.
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This article does not contain any studies with human participants or animals performed by any of the authors.
Silber S (2018) The varicocele argument resurfaces. J Assist Reprod Genet 35(6):1079–1082CrossRefGoogle Scholar
Punab M, Poolamets O, Paju P, Vihljajev V, Pomm K, Ladva R, Korrovits P, Laan M (2016) Causes of male infertility: a 9-year prospective monocentre study on 1737 patients with reduced total sperm counts. Hum Reprod 32(1):18–31PubMedPubMedCentralGoogle Scholar
Alsaikhan B, Alrabeeah K, Delouya G, Zini A (2016) Epidemiology of varicocele. Asian J Androl 18(2):179–181CrossRefGoogle Scholar
Diegidio P, Jhaveri J, Ghannam S, Pinkhasov R, Shabsigh R, Fisch H (2011) Review of current varicocelectomy techniques and their outcomes. BJU Int 108(7):1157–1172CrossRefGoogle Scholar
Hosseini K, Nejatifar M, Kabir A (2018) Comparison of the efficacy and safety of Palomo, Ivanissevich and laparoscopic varicocelectomy in Iranian infertile men with palpable varicocele. Int J Fertil Steril 12(1):81–87PubMedPubMedCentralGoogle Scholar
Muslimov Sh T (2011) Bogdanov AB: [Laparoscopic and microsurgical varicocelectomy: comparison of the results]. Urologiia 6:83–87Google Scholar
Vahidi S, Moein M, Nabi A, Narimani N (2018) Effects of microsurgical varicocelectomy on semen analysis and sperm function tests in patients with different grades of varicocele: Role of sperm functional tests in evaluation of treatments outcome. Andrologia 50(8):e13069CrossRefGoogle Scholar
Esposito C, Escolino M, Castagnetti M, Cerulo M, Settimi A, Cortese G, Turra F, Iannazzone M, Izzo S, Servillo G (2018) Two decades of experience with laparoscopic varicocele repair in children: Standardizing the technique. J Pediatr Urol 14(1):10 e11–10 e17CrossRefGoogle Scholar
Wang H, Ji ZG (2018) Microsurgery versus laparoscopic surgery for varicocele: a meta-analysis and systematic review of randomized controlled trials. J Investig Surg:1–9Google Scholar
Wu X, Liu Q, Zhang R, Wang W, Gao Y (2017) Therapeutic efficacy and safety of laparoscopic surgery versus microsurgery for varicocele of adult males: A meta-analysis. Medicine (Baltimore) 96(34):e7818CrossRefGoogle Scholar
Ding H, Tian J, Du W, 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 Int 110(10):1536–1542CrossRefGoogle Scholar
Cayan S, Shavakhabov S, Kadioglu A (2009) Treatment of palpable varicocele in infertile men: a meta-analysis to define the best technique. J Androl 30(1):33–40CrossRefGoogle Scholar
Chen B, Benedetti A (2017) Quantifying heterogeneity in individual participant data meta-analysis with binary outcomes. Systematic Rev 6(1):243CrossRefGoogle Scholar
Abdel-Maguid AF, Othman I (2010) Microsurgical and nonmagnified subinguinal varicocelectomy for infertile men: a comparative study. Fertil Steril 94(7):2600–2603CrossRefGoogle Scholar
Abdel-Meguid TA, Al-Sayyad A, Tayib A, Farsi HM (2011) Does varicocele repair improve male infertility? An evidence-based perspective from a randomized, controlled trial. Eur Urol 59(3):455–461CrossRefGoogle Scholar
Al-Kandari AM, Shabaan H, Ibrahim HM, Elshebiny YH, Shokeir AA (2007) Comparison of outcomes of different varicocelectomy techniques: open inguinal, laparoscopic, and subinguinal microscopic varicocelectomy: a randomized clinical trial. Urology 69(3):417–420CrossRefGoogle Scholar
Al-Said S, Al-Naimi A, Al-Ansari A, Younis N, Shamsodini A (2008) K As, Shokeir AA: Varicocelectomy for male infertility: a comparative study of open, laparoscopic and microsurgical approaches. J Urol 180(1):266–270CrossRefGoogle Scholar
Bryniarski P, Taborowski P, Rajwa P, Kaletka Z, Zyczkowski M, Paradysz A (2017) The comparison of laparoscopic and microsurgical varicocoelectomy in infertile men with varicocoele on paternity rate 12 months after surgery: a prospective randomized controlled trial. Andrology 5(3):445–450CrossRefGoogle Scholar
Cayan S, Kadioglu TC, Tefekli A, Kadioglu A, Tellaloglu S (2000) Comparison of results and complications of high ligation surgery and microsurgical high inguinal varicocelectomy in the treatment of varicocele. Urology 55(5):750–754CrossRefGoogle Scholar
Qi T, Zhang B, Zhou X (2009) Study on the effect of low-approach microscopic or laparoscopic varicocelectomy in the treatment of varicocele with infertility. Chin J Androl 23:49–52Google Scholar
Orhan I, Onur R, Semerciöz A, Firdolas F, Ardicoglu A, Köksal I (2005) Comparison of two different microsurgical methods in the treatment of varicocele. Arch Androl 51(3):213–220CrossRefGoogle Scholar
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. Eur Urol 60(4):796–808CrossRefGoogle Scholar
Yuan R, Zhuo H, Cao D, Wei Q (2017) Efficacy and safety of varicocelectomies: A meta-analysis. Syst Biol Reprod Med 63(2):120–129CrossRefGoogle Scholar
Wang J, Xia SJ, Liu ZH, Tao L, Ge JF, Xu CM, Qiu JX (2015) Inguinal and subinguinal micro-varicocelectomy, the optimal surgical management of varicocele: a meta-analysis. Asian J Androl 17(1):74–80CrossRefGoogle Scholar
Will MA, Swain J, Fode M, Sonksen J, Christman GM, Ohl D (2011) The great debate: varicocele treatment and impact on fertility. Fertil Steril 95(3):841–852CrossRefGoogle Scholar
Chiba K, Fujisawa M (2016) Clinical Outcomes of Varicocele Repair in Infertile Men: A Review. World J Mens Health 34(2):101–109CrossRefGoogle Scholar