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Kadio
lu
* To whom correspondence should be addressed. E-mail: selcayan{at}mersin.edu.tr.
To date, there have been no randomized, controlled, prospective clinical studies that compare various techniques to describe the best method for the treatment of varicocele in infertile men. This meta-analysis aims to address the best treatment modality of palpable varicocele in infertile men. A MEDLINE search was performed for articles published between January 1980 and April 2008, and we analysed 36 studies reporting postoperative spontaneous pregnancy rates and/or complication rates after varicocele repair using various techniques in infertile men with palpable unilateral or bilateral varicocele. Spontaneous pregnancy rates and postoperative complications such as hydrocele formation, recurrence or persistence were compared among the techniques. In addition, interventional failure with radiologic embolization and reported complications with laparoscopic approach were reviewed. Overall spontaneous pregnancy rates were 37.69% in the Palomo technique series, 41.97% in the microsurgical varicocelectomy techniques, 30.07% in the laparoscopic varicocelectomy techniques, 33.2% in the radiologic embolization and 36% in the macroscopic inguinal (Ivanissevich) varicocelectomy series, revealing significant difference among the techniques (p=0.001). Overall recurrence rates were 14.97% in the Palomo technique series, 1.05% in the microsurgical varicocelectomy techniques, 4.3% in the laparoscopic varicocelectomy techniques, 12.7% in the radiologic embolization and 2.63% in the macroscopic inguinal (Ivanissevich) or subinguinal varicocelectomy series, revealing significant difference among the techniques (p=0.001). Overall hydrocele formation rates were 8.24% in the Palomo technique series, 0.44% in the microsurgical varicocelectomy techniques, 2.84% in the laparoscopic varicocelectomy and 7.3% in the macroscopic inguinal (Ivanissevich) or subinguinal varicocelectomy series, revealing significant difference among the techniques (p=0.001). We conclude that the microsurgical varicocelectomy technique has higher spontaneous pregnancy rates and lower postoperative recurrence and hydrocele formation than conventional varicocelectomy techniques in infertile men. However, prospective, randomized and comparative studies with large number of patients are needed to compare efficacy of microsurgical varicocelectomy to other treatment modalities in infertile men with varicocele.
Key words: Fertility •
Infertility •
Sperm •
Surgery •
Varicocele •
Pregnancy
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