Kohn Taylor P, Ohlander Samuel J, Jacob Jake S, Griffin Tina M, Lipshultz Larry I, Pastuszak Alexander W
Baylor College of Medicine, Houston, TX, USA.
Department of Urology, University of Illinois Hospital and Health Sciences System at Chicago College of Medicine, Chicago, IL, USA.
Curr Urol Rep. 2018 May 17;19(7):53. doi: 10.1007/s11934-018-0798-8.
Current guidelines recommend against surgical repair of subclinical varicoceles (SCVs) for infertility; several studies demonstrate mixed fertility results after SCV correction. To determine whether surgical correction of SCV improves semen parameters and/or reproductive outcomes, we performed a systematic review and meta-analysis. Seven biomedical literature databases were searched through January 2018 for studies that assessed reproductive outcomes and/or change in semen parameters in men with corrected SCV compared to either (1) uncorrected SCV or (2) corrected clinical varicocele. Estimates were pooled using random-effects meta-analysis.
Data were extracted from 13 studies involving 1357 men. Overall, the risk of bias for included studies was high and without a consistent SCV definition across studies. Surgical correction of SCV was associated with a minor increase in sperm density and total motile sperm count (TMSC) compared to uncorrected SCV. This increase in semen parameters is not clinically significant, as men prior to varicocelectomy were on average normospermic nor was correction of a SCV associated with an increase in pregnancy rates when compared to men with uncorrected SCV. Comparing corrected SCV to corrected clinical varicocele, SCV correction resulted in a smaller increase in TMSC but no difference in average annual pregnancy rate. The risk of bias within and heterogeneity between studies assessing SCV correction are high, yet overall very little clinical benefit is derived from SCV correction.
当前指南不建议对亚临床精索静脉曲张（SCV）进行手术修复以治疗不育症；多项研究表明，SCV矫正后的生育结果不一。为了确定SCV的手术矫正是否能改善精液参数和/或生殖结局，我们进行了一项系统评价和荟萃分析。检索了七个生物医学文献数据库，截至2018年1月，查找评估了矫正SCV的男性与以下两者相比的生殖结局和/或精液参数变化的研究：（1）未矫正的SCV或（2）矫正后的临床精索静脉曲张。采用随机效应荟萃分析汇总估计值。
从13项涉及1357名男性的研究中提取了数据。总体而言，纳入研究的偏倚风险较高，且各研究之间没有一致的SCV定义。与未矫正的SCV相比，SCV的手术矫正与精子密度和总活动精子数（TMSC）的小幅增加有关。精液参数的这种增加在临床上并不显著，因为精索静脉曲张切除术之前的男性平均精子正常，而且与未矫正SCV的男性相比，SCV的矫正与妊娠率的增加无关。将矫正后的SCV与矫正后的临床精索静脉曲张进行比较，SCV矫正导致TMSC的增加较小，但平均年妊娠率没有差异。评估SCV矫正的研究内部的偏倚风险和研究之间的异质性较高，但总体而言，SCV矫正带来的临床益处非常小。
