Niu Yonghua, Wang Daoqi, Chen Yinwei, Pokhrel Gaurab, Xu Hao, Wang Tao, Wang Shaogang, Liu Jihong
Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Andrologia. 2018 Nov;50(9):e13078. doi: 10.1111/and.13078. Epub 2018 Jul 19.
Varicocele is the most common cause of male infertility. Varicoceles are classified into two types: clinical and subclinical varicoceles. Some researchers reported right subclinical varicoceles are often accompanied with left clinical varicoceles. However, the treatment is controversial. Our aim was to compare the clinical outcome of unilateral varicocelectomy (UV) and bilateral varicocelectomy (BV) in infertile males with left clinical and right subclinical varicocele. A total of four randomised controlled trials (RCT) were enrolled in this study, including 637 cases with left clinical and right subclinical varicocele (318 cases in the BV group and 319 cases in the UV group). The fixed effects model combined difference in progressive sperm motility between the two groups was 6.42% (95% CI: 5.09, 7.75). The random effects model combined difference in normal sperm morphology between the two groups was 2.04% (95% CI: 0.60, 3.48). The odds ratio shown by the fixed effects model in spontaneous pregnancy rate was 1.73 (95% CI: 1.24, 2.43). No statistically significant difference between the two groups was found in sperm concentration and sperm motility. Thus, BV may be superior to UV for infertile male patients with left clinical and right subclinical varicocele. However, more properly conducted RCTs are still needed.
精索静脉曲张是男性不育最常见的原因。精索静脉曲张分为两种类型：临床型和亚临床型精索静脉曲张。一些研究人员报告称，右侧亚临床型精索静脉曲张常伴有左侧临床型精索静脉曲张。然而，其治疗方法存在争议。我们的目的是比较单侧精索静脉曲张切除术（UV）和双侧精索静脉曲张切除术（BV）对患有左侧临床型和右侧亚临床型精索静脉曲张的不育男性的临床疗效。本研究共纳入四项随机对照试验（RCT），包括637例患有左侧临床型和右侧亚临床型精索静脉曲张的患者（BV组318例，UV组319例）。两组之间精子进行性运动能力的固定效应模型合并差异为6.42%（95%CI：5.09，7.75）。两组之间正常精子形态的随机效应模型合并差异为2.04%（95%CI：0.60，3.48）。固定效应模型显示的自然妊娠率的优势比为1.73（95%CI：1.24，2.43）。两组在精子浓度和精子活力方面未发现统计学上的显著差异。因此，对于患有左侧临床型和右侧亚临床型精索静脉曲张的不育男性患者，BV可能优于UV。然而，仍需要进行更规范的RCT。
