A Systematic Review of Interventional Embolization versus Laparoscopic Surgery for the Treatment of Varicocele_West China Medical Journal

Authors：

 KANGZhen , CHENZhu ,  XIAOEn-hua

Department of Radiology, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P. R. China;

Corresponding?author：

XIAOEn-hua, Email: cjr.xiaoenhua@vip.163.com

Keywords：

Interventional embolization; Laparoscope; Varicocele; Systematic review

DOI：

10.7507/1002-0179.20150190

Video：

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Objective To systematically evaluate the efficiency and safety of interventional embolization versus laparoscopic surgery in the treatment of varicocele. Methods We searched the Chinese Journal Full-text Database, Wanfang Medical Journal Database, and VIP Chinese Science and Technology Journal Full-text Database with such keywords as interventional therapy, embolization, laparoscope, and varicocele. For PubMed and Cochrane Library, MESH terms or keywords were interventional embolization, interventional therapy, embolization, laparoscope, laparoscopic surgery, and varicocele. All database were searched up to March 2015. Then we selected trials comparing interventional embolization versus laparoscopic surgery in the treatment of varicocele according to the including criteria. We assessed the quality of the included studies with the Newcastle-Ottawa Scale and conducted meta-analysis with revman 5.2 for the primary outcomes sperm improvement rate, recurrence rate, complication rate, pregnant rate, etc. Results We included 7 trials comparing interventional embolization with laparoscopic surgery, including 1 prospective study and 6 retrospective studies, with a total of 349 patients receiving interventional therapy and 400 patients receiving laparoscopic surgery. Meta analysis of the included studies showed that there were no significant differences for sperm improvement rate[OR=1.17, 95%CI (0.70, 1.96), P=0.54], pregnant rate[OR=0.58, 95%CI (0.29, 1.13), P=0.11], recurrence rate[OR=0.84, 95CI% (0.40, 1.78), P=0.66] or complication rate[OR=0.68, 95%CI (0.34, 1.32), P=0.25] between the two groups. Conclusion Present evidence shows that there is no significant difference between interventional embolization and laparoscopic surgery for varicocele.

Citation： KANGZhen, CHENZhu, XIAOEn-hua. A Systematic Review of Interventional Embolization versus Laparoscopic Surgery for the Treatment of Varicocele. West China Medical Journal, 2015, 30(4): 656-661. doi: 10.7507/1002-0179.20150190 Copy

1.	Biyani CS1, Cartledge J, Janetschek G. Varicocele[J]. BMJ Clin Evid, 2009(6):1806.
2.	Said SA, Aribarg A, Virutamsen P, et al. The influence of varicocele on parameters of fertility in a large group of men presenting to infertility clinics[J]. Fertil Steril, 1992, 57(6):1289-1293.
3.	Evers JH, Collins J, Clarke J. Surgery or embolisation for varicoceles in subfertile men[J]. Cochrane Database Syst Rev, 2009(1):CD000479.
4.	Evers JH, Collins J,Clarke J. Surgery or embolisation for varicoceles in subfertile men[J]. Cochrane Database Syst Rev, 2008(3):CD000479.
5.	Choi WS, Kim SW. Current issues in varicocele management:a review[J]. World J Mens Health, 2013, 31(1):12-20.
6.	Kroese AC, de Lange NM, Collins J, et al. Surgery or embolization for varicoceles in subfertile men[J]. Cochrane Database Syst Rev, 2012(10):CD000479.
7.	Richter F, Stock JA, Lasalle M, et al. Management of prepubertal varicoceles-results of a questionnaire study among pediatric urologists and urologists with infertility training[J]. Urology, 2001, 58(1):98-102.
8.	Cayan S, Shavakhabov S, Kadio?lu A. Treatment of palpable varicocele in infertile men:a meta-analysis to define the best technique[J]. J Androl, 2008, 30(1):33-40.
9.	許衛國, 李家平, 彭秀斌, 等. 介入栓塞治療精索靜脈曲張的臨床體會[J]. 中國介入影像與治療學, 2008, 5(3):218-220.
10.	羅晟, 張孝斌, 程帆, 等. 開放和腹腔鏡手術治療精索靜脈曲張的Meta分析[J]. 現代泌尿外科雜志, 2013, 18(2):130-133.
11.	Wells GA, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses[EB/OL].[2013-08-01]. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
12.	王乾, 孫敏, 李梅, 等. 介入栓塞與腹腔鏡治療精索靜脈曲張療效觀察[J]. 臨床醫學, 2012, 32(4):66-68.
13.	胡威, 張孝斌. 精索靜脈曲張幾種治療方法的比較[J]. 臨床外科雜志, 2012, 20(8):573-575.
14.	Bechara CF, Weakley SM, Kougias P, et al. Percutaneous treatment of varicocele with microcoil embolization:comparison of treatment outcome with laparoscopic varicocelectomy[J]. Vascular, 2009, 17(Suppl 3):S129-S136.
15.	姜寧, 馬杰, 王國增, 等. 腹腔鏡高位結扎與介入栓塞治療精索靜脈曲張的臨床對比觀察[J]. 中國男科學雜志, 2008, 22(5):45-48.
16.	Yavetz H, Levy R, Papo J, et al. Efficacy of varicocele embolization versus ligation of the left internal spermatic vein for improvement of sperm quality[J]. Int J Androl, 1992, 15(4):338-344.
17.	何順東, 潘毓明. 不同手術方式治療精索靜脈曲張的臨床療效分析[J]. 實用醫學雜志, 2009, 25(10):1615-1617.
18.	魯可權, 許承斌, 曹希亮, 等. 四種手術方式治療精索靜脈曲張412例臨床分析[J]. 醫學臨床研究, 2007, 24(12):2126-2128.
19.	Gat Y, Gornish M, Chakraborty J, et al. Azoospermia and maturation arrest:malfunction of valves in erect poster of humans leads to hypoxia in sperm production site[J]. Andrologia, 2010, 42(6):389-394.
20.	Gazzera C, Rampado O, Savio L, et al. Radiological treatment of male varicocele:technical, clinical, seminal and dosimetric aspects[J]. Radiol Med, 2006, 111(3):449-458.
21.	Freire GC. Surgery or embolization for varicoceles in subfertile men[J]. Sao Paulo Med J, 2013, 131(1):67.
22.	Shrier I, Boivin JF, Steele RJ, et al. Should meta-analyses of interventions include observational studies in addition to randomized controlled trials? A critical examination of underlying principles[J]. Am J Epidemiol, 2007, 166(10):1203-1209.

1. Biyani CS1, Cartledge J, Janetschek G. Varicocele[J]. BMJ Clin Evid, 2009(6):1806.
2. Said SA, Aribarg A, Virutamsen P, et al. The influence of varicocele on parameters of fertility in a large group of men presenting to infertility clinics[J]. Fertil Steril, 1992, 57(6):1289-1293.
3. Evers JH, Collins J, Clarke J. Surgery or embolisation for varicoceles in subfertile men[J]. Cochrane Database Syst Rev, 2009(1):CD000479.
4. Evers JH, Collins J,Clarke J. Surgery or embolisation for varicoceles in subfertile men[J]. Cochrane Database Syst Rev, 2008(3):CD000479.
5. Choi WS, Kim SW. Current issues in varicocele management:a review[J]. World J Mens Health, 2013, 31(1):12-20.
6. Kroese AC, de Lange NM, Collins J, et al. Surgery or embolization for varicoceles in subfertile men[J]. Cochrane Database Syst Rev, 2012(10):CD000479.
7. Richter F, Stock JA, Lasalle M, et al. Management of prepubertal varicoceles-results of a questionnaire study among pediatric urologists and urologists with infertility training[J]. Urology, 2001, 58(1):98-102.
8. Cayan S, Shavakhabov S, Kadio?lu A. Treatment of palpable varicocele in infertile men:a meta-analysis to define the best technique[J]. J Androl, 2008, 30(1):33-40.
9. 許衛國, 李家平, 彭秀斌, 等. 介入栓塞治療精索靜脈曲張的臨床體會[J]. 中國介入影像與治療學, 2008, 5(3):218-220.
10. 羅晟, 張孝斌, 程帆, 等. 開放和腹腔鏡手術治療精索靜脈曲張的Meta分析[J]. 現代泌尿外科雜志, 2013, 18(2):130-133.
11. Wells GA, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses[EB/OL].[2013-08-01]. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
12. 王乾, 孫敏, 李梅, 等. 介入栓塞與腹腔鏡治療精索靜脈曲張療效觀察[J]. 臨床醫學, 2012, 32(4):66-68.
13. 胡威, 張孝斌. 精索靜脈曲張幾種治療方法的比較[J]. 臨床外科雜志, 2012, 20(8):573-575.
14. Bechara CF, Weakley SM, Kougias P, et al. Percutaneous treatment of varicocele with microcoil embolization:comparison of treatment outcome with laparoscopic varicocelectomy[J]. Vascular, 2009, 17(Suppl 3):S129-S136.
15. 姜寧, 馬杰, 王國增, 等. 腹腔鏡高位結扎與介入栓塞治療精索靜脈曲張的臨床對比觀察[J]. 中國男科學雜志, 2008, 22(5):45-48.
16. Yavetz H, Levy R, Papo J, et al. Efficacy of varicocele embolization versus ligation of the left internal spermatic vein for improvement of sperm quality[J]. Int J Androl, 1992, 15(4):338-344.
17. 何順東, 潘毓明. 不同手術方式治療精索靜脈曲張的臨床療效分析[J]. 實用醫學雜志, 2009, 25(10):1615-1617.
18. 魯可權, 許承斌, 曹希亮, 等. 四種手術方式治療精索靜脈曲張412例臨床分析[J]. 醫學臨床研究, 2007, 24(12):2126-2128.
19. Gat Y, Gornish M, Chakraborty J, et al. Azoospermia and maturation arrest:malfunction of valves in erect poster of humans leads to hypoxia in sperm production site[J]. Andrologia, 2010, 42(6):389-394.
20. Gazzera C, Rampado O, Savio L, et al. Radiological treatment of male varicocele:technical, clinical, seminal and dosimetric aspects[J]. Radiol Med, 2006, 111(3):449-458.
21. Freire GC. Surgery or embolization for varicoceles in subfertile men[J]. Sao Paulo Med J, 2013, 131(1):67.
22. Shrier I, Boivin JF, Steele RJ, et al. Should meta-analyses of interventions include observational studies in addition to randomized controlled trials? A critical examination of underlying principles[J]. Am J Epidemiol, 2007, 166(10):1203-1209.

West China Medical Journal

A Systematic Review of Interventional Embolization versus Laparoscopic Surgery for the Treatment of Varicocele

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