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Asian Journal of Andrology 2017The present meta-analysis was conducted to compare the clinical effect and patient experience of laparoendoscopic single-site varicocelectomy (LESSV) and conventional... (Comparative Study)
Comparative Study Meta-Analysis Review
Comparison of surgical effect and postoperative patient experience between laparoendoscopic single-site and conventional laparoscopic varicocelectomy: a systematic review and meta-analysis.
The present meta-analysis was conducted to compare the clinical effect and patient experience of laparoendoscopic single-site varicocelectomy (LESSV) and conventional laparoscopic varicocelectomy. The candidate studies were included after literature search of database Cochrane Library, PubMed, EMBASE, and MEDLINE. Related information on essential data and outcome measures was extracted from the eligible studies by two independent authors, and a meta-analysis was conducted using STATA 12.0 software. Subgroup analyses were conducted by study design (RCT and non-RCT). The odds ratio (OR) or standardized mean difference (SMD) and their 95% confidence intervals (95% CIs) were used to estimate the outcome measures. Seven articles were included in our meta-analysis. The results indicated that patient who had undergone LESSV had a shorter duration of back to work (overall: SMD = -1.454, 95% CI: -2.502--0.405, P = 0.007; non-RCT: SMD = -2.906, 95% CI: -3.796--2.017, P = 0.000; and RCT: SMD = -0.841, 95% CI: -1.393--0.289, P = 0.003) and less pain experience at 3 h or 6 h (SMD = -0.447, 95% CI: -0.754--0.139, P = 0.004), day 1 (SMD = -0.477, 95% CI: -0.905--0.05, P = 0.029), and day 2 (SMD = -0.612, 95% CI: -1.099--0.125, P = 0.014) postoperatively based on RCT studies. However, the meta-analyses based on operation time, clinical effect (improvement of semen quality and scrotal pain relief), and complications (hydrocele and recurrence) yielded nonsignificant results. In conclusion, LESSV had a rapid recovery and less pain experience over conventional laparoscopic varicocelectomy. However, there was no statistically significant difference between the two varicocelectomy techniques in terms of the clinical effect and the incidence of hydrocele and varicocele recurrence. More high-quality studies are warranted for a comprehensive conclusion.
Topics: Endoscopy; Humans; Laparoscopy; Male; Operative Time; Pain, Postoperative; Patient Satisfaction; Postoperative Complications; Semen Analysis; Testicular Hydrocele; Treatment Outcome; Urologic Surgical Procedures, Male; Varicocele
PubMed: 27212128
DOI: 10.4103/1008-682X.181194 -
Cellular Physiology and Biochemistry :... 2016The aim of this study was to elucidate the usefulness of platelet indices, mean platelet volume (MPV), platelet distribution width (PDW), and platelet count in diagnosis... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND/AIMS
The aim of this study was to elucidate the usefulness of platelet indices, mean platelet volume (MPV), platelet distribution width (PDW), and platelet count in diagnosis and monitoring of varicocele.
METHODS
The current study included 525 patients and 379 healthy subjects from five eligible studies. We performed meta-analysis of MPV, PDW, and platelet count and mean differences in these platelet indices between healthy subjects and varicocele patients.
RESULTS
The pooled MPVs were 8.168 fL (95% confidence interval [CI] 7.589 to 8.747) and 8.801 fL (95% CI 8.028 to 9.574) in healthy subjects and varicocele patients, respectively. The pooled mean difference in MPV between healthy subjects and varicocele patients was 0.834 fL in case-control studies (95% CI 0.195 to 1.473, P = 0.011). In both healthy subjects and varicocele patients, low platelet count subgroups showed higher MPV than high platelet count subgroups. The mean difference in MPV was higher in low platelet count subgroup. There was no significant difference in PDW between healthy subjects and varicocele patients.
CONCLUSION
Taken together, our data showed that platelet count was significantly lower in varicocele patients than in healthy subjects. Varicocele patients showed significantly higher MPV and lower platelet count than healthy subjects. MPV levels of patients differed according to platelet counts.
Topics: Blood Platelets; Humans; Male; Mean Platelet Volume; Platelet Count; Varicocele
PubMed: 27189836
DOI: 10.1159/000445579 -
Asian Journal of Andrology 2016Varicocele recurrence is one of the most common complications associated with varicocele repair. A systematic review was performed to evaluate varicocele recurrence... (Review)
Review
Varicocele recurrence is one of the most common complications associated with varicocele repair. A systematic review was performed to evaluate varicocele recurrence rates, anatomic causes of recurrence, and methods of management of recurrent varicoceles. The PubMed database was evaluated using keywords "recurrent" and "varicocele" as well as MESH criteria "recurrent" and "varicocele." Articles were not included that were not in English, represented single case reports, focused solely on subclinical varicocele, or focused solely on a pediatric population (age <18). Rates of recurrence vary with the technique of varicocele repair from 0% to 35%. Anatomy of recurrence can be defined by venography. Management of varicocele recurrence can be surgical or via embolization.
Topics: Adolescent; Adult; Age Factors; Child; Humans; Male; Phlebography; Recurrence; Risk Factors; Treatment Failure; Varicocele; Young Adult
PubMed: 26806078
DOI: 10.4103/1008-682X.171578 -
Asian Journal of Andrology 2016This study investigated the effects of varicocele on semen parameters in infertile men based on the new 2010 World Health Organization laboratory manual for the... (Meta-Analysis)
Meta-Analysis Review
This study investigated the effects of varicocele on semen parameters in infertile men based on the new 2010 World Health Organization laboratory manual for the examination of human semen. Semen analysis results (volume, sperm count, motility, and morphology) were the primary outcomes. An electronic search to collect the data was conducted using the Medline/PubMed, SJU discover, and Google Scholar databases. We searched articles published from 2010 to August 2015, i.e., after the publication of the 2010 WHO manual. We included only those studies that reported the actual semen parameters of adult infertile men diagnosed with clinical varicocele and contained a control group of either fertile men or normozoospermic men who were not diagnosed with varicocele. Ten studies were included in the meta-analysis, involving 1232 men. Varicocele was associated with reduced sperm count (mean difference: -44.48 × 10 [6] ml-1 ; 95% CI: -61.45, -27.51 × 10 [6] ml-1 ; P < 0.001), motility (mean difference: -26.67%; 95% CI: -34.27, -19.08; P < 0.001), and morphology (mean difference: -19.68%; 95% CI: -29.28, -10.07; P < 0.001) but not semen volume (mean difference: -0.23 ml; 95% CI: -0.64, 0.17). Subgroup analyses indicated that the magnitude of effect was influenced by control subtype but not WHO laboratory manual edition used for semen assessment. We conclude that varicocele is a significant risk factor that negatively affects semen quality, but the observed pooled effect size on semen parameters does not seem to be affected by the WHO laboratory manual edition. Given most of the studies published after 2010 still utilized the 1999 manual for semen analysis, further research is required to fully understand the clinical implication of the 2010 WHO laboratory manual on the association between varicocele and semen parameters.
Topics: Adult; Humans; Male; Semen; Semen Analysis; Sperm Count; Varicocele; World Health Organization
PubMed: 26780872
DOI: 10.4103/1008-682X.172638 -
Asian Journal of Andrology 2016Varicocele is a common problem in reproductive medicine practice. A varicocele is identified in 15% of healthy men and up to 35% of men with primary infertility. The... (Review)
Review
Varicocele is a common problem in reproductive medicine practice. A varicocele is identified in 15% of healthy men and up to 35% of men with primary infertility. The exact pathophysiology of varicoceles is not very well understood, especially regarding its effect on male infertility. We have conducted a systematic review of studies evaluating the epidemiology of varicocele in the general population and in men presenting with infertility. In this article, we have identified some of the factors that can influence the epidemiological aspects of varicoceles. We also recognize that varicocele epidemiology remains incompletely understood, and there is a need for well-designed, large-scale studies to fully define the epidemiological aspects of this condition.
Topics: Humans; Infertility, Male; Male; Varicocele
PubMed: 26763551
DOI: 10.4103/1008-682X.172640 -
Asian Journal of Andrology 2016The objective of this systemic review was to evaluate the benefit of repairing clinical varicocele in infertile men with nonobstructive azoospermia (NOA). The surgically... (Meta-Analysis)
Meta-Analysis Review
The objective of this systemic review was to evaluate the benefit of repairing clinical varicocele in infertile men with nonobstructive azoospermia (NOA). The surgically obtained sperm retrieval rate (SRR) and pregnancy rates following assisted reproductive technology (ART) with the use of retrieved testicular sperm were the primary outcomes. The secondary outcomes included the presence of viable sperm in postoperative ejaculate to avoid the testicular sperm retrieval and pregnancy rates (both assisted and unassisted) using postoperative ejaculated sperm. An electronic search to collect the data was performed using the MEDLINE and EMBASE databases until April 2015. Eighteen studies were included in this systematic review and accounted for 468 patients who were diagnosed with NOA and varicocele. These patients were subjected to either surgical varicocele repair or percutaneous embolization. Three controlled studies evaluating sperm retrieval outcomes indicated that in patients who underwent varicocelectomy, SRR increased compared to those without varicocele repair (OR: 2.65; 95% CI: 1.69-4.14; P< 0.001). Although pregnancy rates with the use of testicular sperm favored the varicocelectomy group, results were not statistically significant (clinical pregnancy rate OR: 2.07; 95% CI: 0.92-4.65; P= 0.08; live birth rate OR: 2.19; 95% CI: 0.99-4.83; P= 0.05). The remaining fifteen studies reported postoperative semen analysis results. In 43.9% of the patients (range: 20.8%-55.0%), sperm were found in postoperative ejaculates. Pregnancy rates for unassisted and assisted (after IVF/ICSI) were 13.6% and 18.9% in the group of men with sperm in postoperative ejaculates, respectively. Our findings indicate that varicocelectomy in patients with NOA and clinical varicocele is associated with improved SRR. In addition, approximately 44% of the treated men will have enough sperm in the ejaculate to avoid sperm retrieval. Limited data on pregnancy outcomes with both postoperative ejaculated sperm and harvested testicular sperm preclude any firm conclusion with regard to the possible increased fertility potential in treated individuals. In conclusion, the results of our study indicate that infertile men with NOA and clinical varicocele benefit from varicocelectomy. Given the low/moderate quality of evidence available, it is advisable that doctors discuss with their patients with NOA the risks and benefits of varicocele repair.
Topics: Azoospermia; Humans; Male; Reproductive Techniques, Assisted; Spermatozoa; Testis; Treatment Outcome; Varicocele
PubMed: 26680033
DOI: 10.4103/1008-682X.169562 -
Asian Journal of Andrology 2016A systematic review was conducted to identify and qualitatively analyze the methods as well as recommendations of Clinical Practice Guidelines (CPG) and Best Practice... (Review)
Review
A systematic review was conducted to identify and qualitatively analyze the methods as well as recommendations of Clinical Practice Guidelines (CPG) and Best Practice Statements (BPS) concerning varicocele in the pediatric and adolescent population. An electronic search was performed with the MEDLINE, EMBASE, Science Direct, and Scielo databases, as well as guidelines' Web sites until September 2015. Four guidelines were included in the qualitative synthesis. In general, the recommendations provided by the CPG/BPS were consistent despite the existence of some gaps across the studies. The guidelines issued by the American Urological Association (AUA) and American Society for Reproductive Medicine (ASRM) did not provide evidence-based levels for the recommendations given. Most of the recommendations given by the European Association of Urology (EAU) and European Society of Pediatric Urology (ESPU) were derived from nonrandomized clinical trials, retrospective studies, and expert opinion. Among all CPG/BPS, only one was specifically designed for the pediatric population. The studied guidelines did not undertake independent cost-effectiveness and risk-benefit analysis. The main objectives of these guidelines were to translate the best evidence into practice and provide a framework of standardized care while maintaining clinical autonomy and physician judgment. However, the limitations identified in the CPG/BPS for the diagnosis and management of varicocele in children and adolescents indicate ample opportunities for research and future incorporation of higher quality standards in patient care.
Topics: Adolescent; Child; Cost-Benefit Analysis; Humans; Male; Practice Guidelines as Topic; Risk Assessment; Varicocele
PubMed: 26680032
DOI: 10.4103/1008-682X.169559 -
Asian Journal of Andrology 2016Varicocele affects approximately 35%-40% of men presenting for an infertility evaluation. There is fair evidence indicating that surgical repair of clinical varicocele... (Meta-Analysis)
Meta-Analysis Review
Varicocele affects approximately 35%-40% of men presenting for an infertility evaluation. There is fair evidence indicating that surgical repair of clinical varicocele improves semen parameters, decreases seminal oxidative stress and sperm DNA fragmentation, and increases the chances of natural conception. However, it is unclear whether performing varicocelectomy in men with clinical varicocele prior to assisted reproductive technology (ART) improve treatment outcomes. The objective of this study was to evaluate the role of varicocelectomy on ART pregnancy outcomes in nonazoospermic infertile men with clinical varicocele. An electronic search was performed to collect all evidence that fitted our eligibility criteria using the MEDLINE and EMBASE databases until April 2015. Four retrospective studies were included, all of which involved intracytoplasmic sperm injection (ICSI), and accounted for 870 cycles (438 subjected to ICSI with prior varicocelectomy, and 432 without prior varicocelectomy). There was a significant increase in the clinical pregnancy rates (OR = 1.59, 95% CI: 1.19-2.12, I 2 = 25%) and live birth rates (OR = 2.17, 95% CI: 1.55-3.06, I 2 = 0%) in the varicocelectomy group compared to the group subjected to ICSI without previous varicocelectomy. Our results indicate that performing varicocelectomy in patients with clinical varicocele prior to ICSI is associated with improved pregnancy outcomes.
Topics: Female; Humans; Infertility, Male; Male; Pregnancy; Reproductive Techniques, Assisted; Semen Analysis; Treatment Outcome; Varicocele
PubMed: 26510504
DOI: 10.4103/1008-682X.163269 -
BMJ Clinical Evidence Jul 2015Varicocele is estimated to affect about 15% of the general male population. It usually occurs only on the left side, and is often asymptomatic. There is little evidence... (Review)
Review
INTRODUCTION
Varicocele is estimated to affect about 15% of the general male population. It usually occurs only on the left side, and is often asymptomatic. There is little evidence that varicocele reduces male fertility, although it is found in 12% of male partners of couples presenting with infertility and in 25% of men with abnormal semen analysis.
METHODS AND OUTCOMES
We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of treatments in adult males with varicocele? We searched: Medline, Embase, The Cochrane Library, and other important databases up to November 2013 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview).
RESULTS
Searching of electronic databases retrieved 203 studies. After deduplication and removal of conference abstracts, 91 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 53 studies and the further review of 38 full publications. Of the 38 full articles evaluated, one existing systematic review was updated and two systematic reviews and five RCTs were added at this update. We performed a GRADE evaluation of nine PICO combinations.
CONCLUSIONS
In this systematic overview we categorised the efficacy for four interventions, based on information relating to the effectiveness of embolisation, expectant management, sclerotherapy, and surgical ligation.
Topics: Humans; Male; Sclerotherapy; Varicocele
PubMed: 26168774
DOI: No ID Found -
Evidence-based Complementary and... 2015Objective. The objective of this study was to conduct a systematic review to assess the effectiveness and safety of traditional Chinese herb combined with surgery for... (Review)
Review
Objective. The objective of this study was to conduct a systematic review to assess the effectiveness and safety of traditional Chinese herb combined with surgery for male varicocele infertility compared to surgery. Methods. Randomized controlled trials (RCTs) data of traditional Chinese herbs combined with surgery for male varicocele fertility versus surgery were collected by searching the Cochrane Library, Embase, PubMed, and Chinese databases. The risk of bias was assessed using Cochrane Handbook. Study outcomes were presented as risk ratios (RRs) for dichotomous data. Results. Seventeen of 72 potentially relevant trials met the inclusion criteria. The methodological qualities of the RCTs were low. Compared with the surgery group, the traditional Chinese herb combined with surgery group had superiority in pregnancy rate at 3-month (RR = 1.76, and P = 0.008), 6-month (RR = 1.58, and P = 0.0005), and 2-year (RR = 1.58, and P = 0.0005) follow-ups. No RCT was found to describe the side effects. Conclusion. On considering the low methodological quality of RCTs, there was no enough evidence on traditional Chinese herb with surgery for male varicocele infertility, and more high-quality RCTs of large sample sizes are required.
PubMed: 25705240
DOI: 10.1155/2015/689056