Comparison between Microsurgical Varicocelectomy with and without Testicular Delivery for Treatment of Varicocele: An Updated Systematic Review and Meta-Analysis

Abstract

Dilated testicular gubernacular veins after varicocelectomy were reported to be the cause of varicocele recurrence. The gubernacular veins start at the tail of the testicular and merges into the posterior scrotal veins. The gubernacular veins could be ligated only after testicular delivery (TD) anatomically. TD and ligation of the gubernacular veins during microsurgical varicocelectomy might reduce the varicocele recurrence but this method is still under debate. Therefore, we performed this systematic review and meta-analysis and assessed varicocele recurrence, complications as well as clinical outcomes after microsurgical varicocelectomy with TD. Relevant researches were searched on the PubMed, Embase, Cochrane Library, Web of Science, and China National Knowledge Infrastructure databases to perform an updated meta-analysis. Standardized mean differences, relative risks (RRs), and their 95% confidence intervals (CIs) were applied to evaluate result indicators. This updated meta-analysis included 17 publications with 10 randomized controlled trials and 7 cohort studies. A total of 2,254 participants, including 1,024 subjects with TD and 1,230 without TD, were involved. The pooled results demonstrated that microsurgical varicocelectomy with TD might lead to higher incidences of postoperative scrotal edema (RR = 4.20, 95% CI = 2.60–6.81, $p<0.001$ ), testicular hydrocele (RR = 6.58, 95% CI = 1.19–36.20, $p=0.030$ ), and orchiepididymitis (RR = 6.33, 95% CI = 2.08–19.31, $p=0.001$ ) than the group without TD. Similar findings were also found in subgroup analysis of varicocele grade II and III. By contrast, we failed to find significant differences between them in semen parameters, varicocele recurrence, serum testosterone, and natural pregnancy ( $p>0.05$ ). Sensitivity analysis revealed the pooled results were stable and no publication bias was detected. TD during microsurgical varicocelectomy may lead to more postoperative complications and may not be beneficial for semen parameters, recurrence of varicocele, and natural pregnancy. Therefore, varicocele patients may not benefit more from TD.