Efficacy And Safety Of Microsurgical Varicocelectomy With And Without Testicular Delivery:A Meta-analysis

Objective: To systematically evaluate the efficacy and safety of MV with(ligation of gubernacular veins and external spermatic perforators)and without(retaining of gubernacular veins and external spermatic perforators)testicular delivery for the treatment of male with varicocele.Methods: Taking MV,testicular delivery and gubernacular veins as the search words and searching PubMed,China Nationnal Knowledge Infrastructure,Wanfang database,Meta analysis was performed on the literature in accordance with the inclusive criteria using Revman5.3.Results: A total of 655 relevant articles were retrieved.After screening and reading the full text,8 articles were included finally in which there were 4 Chinese articles and 4 English articles.Meta analysis showed that1.Ooperation time: compared with the operation time of the two groups,the combined effect volume [IV=12.06,95% CI(4.74,19.38),P =0.001] was statistically significant,suggesting that the operation time difference between the two groups was 12.06 min,and with testicular delivery group in operation time was longer than without testicular delivery group.2.Recurrence rate: There was no significant difference in the recurrence rate between the two groups [OR=0.64,95% CI(0.12,3.42),P=0.60].There was no difference between the recurrence rates between the two groups.3.Postoperative complications: complications were divided into 3 subgroups for analysis of hydrocele or scrotal edema,showing a statistically significant difference between the two groups [OR=5.36,95%CI(2.57,11.16),P<0.00001],suggesting that without testicular delivery group have a lower incidence than with testicular delivery group in hydrocele or scrotal edema,testicular pain or paresthesia,showing a statistically significant difference between the two groups [OR=5.35,95%CI(1.96,14.64),P=0.001],suggesting that without testicular delivery group have a lower incidence than with testicular delivery group in hydrocele or scrotal edema,orchitis or epididymitis: the difference between the two groups was not statistically significant [OR=3.11,95%CI(0.31,30.75),P= 0.33].4.Semen parameters: sperm motility: both of the two groups were improved after surgery and higher than preoperative(IV16.53,95% CI(13.61,19.45),P < 0.00001],IV 14.85,95% CI(13.72).,15.98),P < 0.00001],sperm density: both of the two groups were improved after surgery and higher than preoperative [IV 1.44(0.33,2.54),P = 0.01 1.64(0.26,3.01),P = 0.02]Conclusions:MV with testicular delivery group was longer operation time than without testicular delivery group,postoperative complications have a higher incidence of hydrocele or scrotal edema,testicular pain or paresthesia.The incidence of orchitis or epididymitis,recurrence rate was low and there was no difference between the two groups.Testicular atrophy did not occur.Sperm parameters were significantly improved after surgery compared with preoperative.Therefore,the treatment of varicocele in without testicular delivery group has some advantages.