Presentation Authors: Selahittin Çayan*, Mersin, Turkey, İrfan Orhan, Elazığ, Turkey, Erdem Akbay, Mersin, Turkey, Ateş Kadıoğlu, Istanbul, Turkey
Introduction: Recurrent varicoceles have been previously treated with radiological methods. The aim of this study was to define the best method in the treatment of recurrent varicoceles.
Methods: A PubMed search was performed for articles published between January 1980 and August 2018. We analyzed 21 studies, reporting post-treatment sperm parameters, pregnancy and complication rates in men who underwent treatment for recurrent varicocele. The studies were analyzed as open surgery: 10 (microscopic: 7 and macroscopic: 3), radiologic intervention: 9, open macroscopic versus laparoscopic surgery: 1 and open microscopic versus radiologic intervention: 1. Post-treatment improvement in semen parameters, spontaneous pregnancy and complication rates were compared between the treatment methods. In addition, interventional failure with radiologic embolization and sub-surgical techniques related to surgical and radiologic methods were reviewed.
Results: Overall pregnancy rates were 44.3% in the surgical methods and 17.9% in the radiological interventions, revealing significant difference between the two techniques (p=0.007). Post-treatment improvement rates in sperm parameters were significantly higher in the open surgical methods (76.5%) than in the radiological interventions (62.5%) (p=0.032). Post-treatment recurrence rates were 3.8% in the open surgical methods, 17.6% in the laparoscopic surgery and 3.3% in the radiological interventions. However, technical failure rate was 13.38% in the radiological interventions. Recurrence rate was 0.6% in the microsurgical methods and 19.7% in the macroscopic methods, revealing significant difference (p=0.000). Post-treatment testicular atrophy rates were significantly higher in the laparoscopic surgery (2.9%) and macroscopic surgery (1.6%) than in the microscopic surgery (0%) (p=0.024). No significant differences were observed in post-treatment hydrocele and hematoma-infection rates among the treatment methods.
Conclusions: Surgical methods have higher pregnancy rates and higher improvement in sperm parameters than radiological interventions in the treatment of recurrent varicocele. In addition, microsurgical redo varicocele repair has lower recurrence and testicular atrophy rates than macroscopic varicocelectomy series. Patients with recurrence varicoceles should be informed in light of these findings. However, prospective and comparative studies are needed to define the best treatment method in men with recurrent varicocele.