Cayan Selahittin, Shavakhabov Shavkat, Kadioğlu Ateş
University of Mersin School of Medicine, Department of Urology, 33079-Mersin, Turkey.
J Androl. 2009 Jan-Feb;30(1):33-40. doi: 10.2164/jandrol.108.005967. Epub 2008 Sep 4.
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 for palpable varicocele in infertile men. A MEDLINE search was performed for articles published between January 1980 and April 2008, and we analyzed 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 the 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 differences among the techniques (P = .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 = .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 = .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 the efficacy of microsurgical varicocelectomy with that of other treatment modalities in infertile men with varicocele.
迄今为止，尚无随机、对照、前瞻性临床研究比较各种技术以确定治疗不育男性精索静脉曲张的最佳方法。本荟萃分析旨在探讨不育男性可触及精索静脉曲张的最佳治疗方式。我们在MEDLINE数据库中检索了1980年1月至2008年4月发表的文章，并分析了36项研究，这些研究报告了采用各种技术对单侧或双侧可触及精索静脉曲张的不育男性进行精索静脉曲张修复术后的自然妊娠率和/或并发症发生率。我们比较了不同技术之间的自然妊娠率以及术后并发症，如鞘膜积液形成、复发或持续存在情况。此外，还回顾了放射栓塞介入失败情况以及腹腔镜手术方法报告的并发症。Palomo技术系列的总体自然妊娠率为37.69%，显微外科精索静脉结扎术技术为41.97%，腹腔镜精索静脉结扎术技术为30.07%，放射栓塞术为33.2%，宏观腹股沟（Ivanissevich）精索静脉结扎术系列为36%，不同技术之间存在显著差异（P = .001）。Palomo技术系列的总体复发率为14.97%，显微外科精索静脉结扎术技术为1.05%，腹腔镜精索静脉结扎术技术为4.3%，放射栓塞术为12.7%，宏观腹股沟（Ivanissevich）或腹股沟下精索静脉结扎术系列为2.63%，不同技术之间存在显著差异（P = .001）。Palomo技术系列的总体鞘膜积液形成率为8.24%，显微外科精索静脉结扎术技术为0.44%，腹腔镜精索静脉结扎术为2.84%，宏观腹股沟（Ivanissevich）或腹股沟下精索静脉结扎术系列为7.3%，不同技术之间存在显著差异（P = .001）。我们得出结论，在不育男性中，显微外科精索静脉结扎术技术比传统精索静脉结扎术技术具有更高的自然妊娠率以及更低的术后复发率和鞘膜积液形成率。然而，需要进行大量患者的前瞻性、随机和比较性研究，以比较显微外科精索静脉结扎术与其他治疗方式对不育男性精索静脉曲张的疗效。
