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The role of testicular artery in laparoscopic varicocelectomy: a systematic review and meta-analysis

  • Urology - Original Paper
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Abstract

Purpose

We performed this meta-analysis to evaluate the efficacy and safety of artery preserving versus artery non-preserving in laparoscopic varicocelectomy.

Methods

All publications up until October 2015 were searched in PubMed, EMBASE, Ovid, Web of Science, and Cochrane library. Randomized controlled trials (RCTs) and cohort studies (CSs) that compared the difference in two operative approaches in laparoscopic varicocelectomy were included. Statistical analysis was performed using Stata version 12.0.

Results

A total of four RCTs and ten CSs involving 503 cases with artery preserving and 911 cases with artery non-preserving met our inclusion criteria. Meta-analysis showed that artery preserving had higher recurrence rate [risk ratio (RR) = 2.91, 95 % confidence interval (CI) 1.83–4.61; P = 0.000], lower incidence of hydrocele formation (RR = 0.18; 95 % CI 0.08–0.42; P = 0.000), and prolonged operating time [standard mean difference (SMD) = 1.27; 95 % CI 0.17–2.37; P = 0.023], compared with artery non-preserving in laparoscopic varicocelectomy. The results were similar in postoperative catch-up growth (RR = 1.00; 95 % CI 0.86–1.17; P = 0.985) and testicular atrophy (RR = 0.36; 95 % CI 0.09–1.54; P = 0.169). Besides, no significant difference was found in sperm concentration, motility, and normal morphology between two groups, as well as on postoperative pregnancy rate (RR = 0.95; 95 % CI 0.65–1.40; P = 0.809).

Conclusion

With the advantages of less recurrence, easier operating and less time spending, and comparable results in other respects, artery non-preserving is preferable to artery preserving in laparoscopic varicocelectomy, although there is a relatively high incidence of hydrocele formation. Considering the limitation of included studies, more large-scaled RCTs are required to confirm the present findings.

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Acknowledgments

The authors would like to acknowledge Professor Shaowen Tang of School of Public Health of Nanjing Medical University for his assistance in the literature searching and statistical analysis of this study.

Author contributions

XKQ, KPW, and WZ conceived and designed the study. XKQ and KPW searched the literatures. ZX and YJY assessed the study quality and collected the data. XKQ and YJY performed the statistical analysis. XKQ, KPW, and ZX drafted the manuscript; WZ and GCZ participated in critical revision of the manuscript. All authors read and approved the final manuscript.

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    Authors and Affiliations

    1. Department of Urology, Subei People’s Hospital, No. 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China

      Xiaokang Qi, Guangchen Zhou & Junjie Yu

    2. Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China

      Xiaokang Qi, Zhen Xu & Wei Zhang

    3. Department of Urology, The First People’s Hospital of Lianyungang City, No. 182 North Tongguan Road, Xinpu District, Lianyungang, 222002, Jiangsu, China

      Kunpeng Wang

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    Correspondence to Wei Zhang.

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    Xiaokang Qi and Kunpeng Wang have contributed equally to this work.

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    Qi, X., Wang, K., Zhou, G. et al. The role of testicular artery in laparoscopic varicocelectomy: a systematic review and meta-analysis. Int Urol Nephrol 48, 955–965 (2016). https://doi.org/10.1007/s11255-016-1254-7

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