Efficacy and safety of microsurgical subinguinal varicocelectomy with and without testicular delivery for varicocele patients: A systematic review and meta-analysis.

Purpose: This study reviewed the efficacy and safety of the microsurgical subinguinal varicocelectomy (MSV) with and without testicular delivery (TD) for varicocele patients. Materials and Methods: A systematic literature search was conducted in the EMBASE, PubMed, MEDLINE, Cochrane databases, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), and Google Scholar to identify relevant studies that reported MSV with and without TD for varicocele patients published in English or Chinese up to October 2018. The Newcastle-Ottawa Scale (NOS) and the Jadad scores were used to evaluate the methodological quality of all the included studies. We also used the?Cochrane?Collaboration’s?tool?for?assessing?risk?of?bias for each study. The Review Manager Software 5.3 was used to conduct data analysis. Results: Four RCTs and three retrospective studies of 993 patients were included, the meta-analysis results indicated that both of two treatments were effective and safe. MSV with TD had lower recurrence rate (OR=0.20, 95% CI: 0.06-0.65, P=.007, I 2 = 0%) and postoperative serum testosterone level (MD = -39.07, 95%CI: -51.95--26.18, P = .00001, I 2 = 0%), but higher postoperative complications rate (OR=7.35, 95% CI: 2.92-18.53, P<.0001, I 2 = 0%) compared with MSV without TD. We found no significant differences in operation time(MD = 12.46, 95% CI:0.11-24.81,P=.05, I 2 = 87%), sperm concentration(MD = 3.73, 95%CI: -2.88-10.35, P = .27, I 2 = 81%), sperm motility(MD = 10.96, 95%CI: -11.93-33.86,P =.35, I 2 = 99%), and pregnancy rate(OR = 0.65, 95%CI: 0.37-1.16,P = .15,I 2 = 0%). Conclusion: This meta-analysis compared efficacy and safety of MSV with and without TD for varicocele patients. MSV with TD had high postoperative complications rate but lower recurrence rate and postoperative serum testosterone level than MSV without TD. In term of serum testosterone level, operation time, sperm concentration, sperm motility and pregnancy rate, we found no significant differences between two.