Department of Urology, Hamad Medical Corporation, Doha, Qatar.
Clinical Urology, Weill Cornell Medicine -Qatar, Doha, Qatar.
Andrologia. 2022 Nov;54(10):e14525. doi: 10.1111/and.14525. Epub 2022 Jul 17.
Recurrence following varicocelectomy is an important cause of treatment failure and persistence of subnormal semen parameters. This original study was combined with a systemic review and meta-analysis aiming to evaluate the efficacy of redo varicocelectomy on male fertility potential and pregnancy outcome. The retrospective study included 32 patients who underwent microsurgical subinguinal varicocelectomy for patients with recurrent varicocele. Changes in semen parameters and hormone profiles before and after surgery were compared. The literature review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and included seven articles in addition to our original report. Results of the original study revealed statistically significant improvements in sperm concentration, progressive motility, total motile sperm count and normal morphology following redo varicocelectomy. The meta-analysis results echoed those reported in our original study and depicted significant improvements in sperm concentration (mean difference [MD] = +20.281 million/ml, p < 0.001), total motility (MD = +9.659%, p = 0.001), total motile sperm count (MD = +23.258 million sperm, p < 0.001) and normal morphology (MD = +4.460%, p < 0.001). Overall pregnancy outcome was reported in seven studies with a rate of 34.6%. No significant changes were noted in any of the collected hormone results both in this original report and in the meta-analysis. In conclusion, redo varicocelectomy has a beneficial role on male fertility potential and can be offered for men with recurrent varicocele as directed by their individual clinical condition.
精索静脉曲张手术后复发是治疗失败和精液参数持续异常的重要原因。本原始研究结合系统回顾和荟萃分析,旨在评估再次精索静脉曲张手术对男性生育能力和妊娠结局的疗效。回顾性研究纳入 32 例因复发性精索静脉曲张而行显微镜下精索静脉低位结扎术的患者。比较手术前后精液参数和激素谱的变化。文献综述遵循系统评价和荟萃分析的首选报告项目,并包括我们原始报告之外的 7 篇文章。原始研究结果显示,再次精索静脉曲张手术后精子浓度、前向运动精子百分率、总活动精子计数和正常形态均有统计学意义的改善。荟萃分析结果与我们的原始研究报告一致,显示精子浓度(均数差 [MD] = +20.281 百万/ml,p < 0.001)、总活力(MD = +9.659%,p = 0.001)、总活动精子计数(MD = +23.258 百万精子,p < 0.001)和正常形态(MD = +4.460%,p < 0.001)均有显著改善。7 项研究报告了总体妊娠结局,发生率为 34.6%。本原始报告和荟萃分析均未发现任何收集激素结果有显著变化。总之,再次精索静脉曲张手术对男性生育能力有有益作用,可以根据患者的个体临床情况为复发性精索静脉曲张患者提供。