Department of Urology and Andrology, Faculty of Fundamental Medicine, Lomonosov Moscow State University, Moscow 119991, Russia.
Department of Urology, Tashkent Medical Academy, Tashkent 100109, Uzbekistan.
Asian J Androl. 2023 Jan-Feb;25(1):21-28. doi: 10.4103/aja2021125.
In this review, we tried to systematize all the evidence (from PubMed [MEDLINE], Scopus, Cochrane Library, EBSCO, Embase, and Google Scholar) from 1993 to 2021 on the predictors of microsurgical varicocelectomy efficacy in male infertility treatment. Regarding the outcomes of varicocele repair, we considered semen improvement and pregnancy and analyzed them separately. Based on the 2011 Oxford CEBM Levels of Evidence, we assigned a score to each trial that studied the role of the predictor. We systematized the studied predictors based on the total points, which were, in turn, calculated based on the number and quality of studies that confirmed or rejected the studied predictor as significant, into three levels of significance: predictors of high, moderate, and low clinical significance. Preoperative total motile sperm count (TMSC) coupled with sperm concentration can be a significant predictor of semen improvement and pregnancy after varicocelectomy. In addition, for semen improvement alone, scrotal Doppler ultrasound (DUS) parameters, sperm DNA fragmentation index (DFI), and bilateral varicocelectomy are reliable predictors of microsurgical varicocelectomy efficacy.
在这篇综述中，我们试图系统地整理了 1993 年至 2021 年间所有关于精索静脉曲张显微外科手术疗效预测因素的证据（来自 PubMed [MEDLINE]、Scopus、Cochrane 图书馆、EBSCO、Embase 和 Google Scholar）。关于精索静脉曲张修复的结果，我们考虑了精液改善和妊娠，并分别进行了分析。根据 2011 年牛津循证医学中心的证据水平，我们为每个研究预测因素作用的试验分配了一个分数。我们根据总分对研究的预测因素进行了系统的整理，总分又是根据确认或否定研究预测因素的研究数量和质量计算得出的，分为高、中、低三个临床意义水平。术前总活动精子计数（TMSC）与精子浓度相结合可以成为精索静脉曲张显微外科手术后精液改善和妊娠的重要预测因素。此外，对于单纯的精液改善，阴囊多普勒超声（DUS）参数、精子 DNA 碎片指数（DFI）和双侧精索静脉曲张切除术是精索静脉曲张显微外科手术疗效的可靠预测因素。
