Effectiveness and Safety of Microscopic Varicocelectomy versus Palomo Surgery for Varicocele: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

JIN Peng ,  YANG Luoyan , PENG Yougong

Department of Urology, The Second Xiangya Hospital, Central South University, Changsha 410011, China;

Corresponding author：

YANG Luoyan, Email: sdyangluoyan@yahoo.com.cn

Keywords：

Varicocele; Microscopic varicocelectomy; Palomo surgery; Randomized controlled trial; Meta-analysis

DOI：

10.7507/1672-2531.20090120

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective 　To evaluate the effectiveness and safety of microsurgical varicocelectomy (MV) compared with Palomo surgery for male varicocele.
Methods 　MEDLINE (1985-October 2008), EMbase (1990-October 2008), China Biology Medicine Literature Disc Database (1979-October 2008), CMCC (1979-October 2008) and CNKI (1990-October 2008) were searched electronically by computer. Addtionally, four relevant journals were searched manually to get randomized controlled clinical trials about the comparison of MV and Palomo in the treatment of varicocele. Two reviewers screened the literature, evaluated the document quality, extracted the data independently, and checked the result together. RevMan software version 4.3.1 developed by the Cochrane Collaborative was used for meta-analysis.
Results 　Seven RCTs reporting data on effectiveness and safety of MV versus palomo surgery were included. Meta-analyses showed that MV was superior to palomo surgery in improving sperm motility [RR= 1.21, 95%CI (1.09, 1.34), P=0.000 5], concentration [RR= 1.35, 95%CI (1.20, 1.51), P lt;0.000 01] and also postoperation natural pregnancy rate [RR= 1.34，95%CI (1.08, 1.66), P=0.008]. While the MV group had a longer operation time in unilateral [WMD= 23.01 min, 95%CI (16.86, 29.16), P lt;0.000 01] or bilateral varicocele [WMD= 34.05 min, 95%CI (4.9, 63.21), P=0.02] than Palomo surgery. The recovery time difference in the two groups was not significant. The incidence of varicocele recurrence was significantly lower in the MV group than in the Palomo group [RR= 0.17, 95%CI (0.10, 0.31), P lt;0.000 01], and the incidence of postoperative hydrocele was also significantly lower in the MV group than in the Palomo group [RR= 0.10, 95%CI (0.05, 0.23), P lt;0.000 01]. The incidences of wound infection, scrotal hematoma and scrotal pain were similar in both groups.
Conclusion 　The evidence shows that MV is superior to Palomo surgery because of the higher sperm improvement rate, higher natural pregnancy rate and lower incidence of recurrence and hydrocele. But the operation time is longer. The long-term effect and overall effectiveness of MV need more high-quality RCTs to confirm.

Citation： JIN Peng,YANG Luoyan,PENG Yougong. Effectiveness and Safety of Microscopic Varicocelectomy versus Palomo Surgery for Varicocele: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2009, 09(6): 674-680. doi: 10.7507/1672-2531.20090120 Copy

1.	World Health Organization. The influence of varicocele on parameters of fertility in a large group of men presenting to fertility clinics. Fertil Steril, 1992, 57: 1289-1293.
2.	吴阶平. 吴阶平泌尿外科学. 济南: 山东科技出版社, 2004: 1953.
3.	Goldstein M, Gilbert BR, Dicker AP, et al. Microsurgical inguinal varicocelectomy with delivery of the testis: an artery and lymphatic sparing technique. J Urol, 1992, 148(6): 1808-1811.
4.	Evers JLH , Collins JA. Assessment of efficacy of varicocele repair for male subfertility: a systematic review. Lancet, 2003, 361: 1849.
5.	Ficarra V, Cerruto MA, Liguori G, et al. Treatment of Varicocele in Subfertile Men: The Cochrane Review-A Contrary Opinion. Eur Urol, 2006, 49: 258-263.
6.	Mulrow CD, Oxman AD. The Cochrane Collaboration handbook, Issue 1, 2000, Oxford, Update Software.
7.	Al-Kandari AM, Shabaan H, Ibrahim HM, et al. Comparison of outcomes of different varicocelectomy techniques: open inguinal, laparoscopic, and subinguinal microscopic varicocelectomy: a randomized clinical trial. Urology, 2007, 69(3): 417-420.
8.	Al-Said S, Al-Naimi A, Al-Ansari A, et al. Varicocelectomy for Male Infertility: A Comparative Study of Open, Laparoscopic and Microsurgical Approaches. J Urol, 2008, 180(1): 266-270.
9.	Barbalias GA, Liatsikos EN, Nikiforidis G, et al. Treatment of varicocele for male infertility: a comparative study evaluating currently used approaches. Eur Urol, 1998, 34(5): 393-398.
10.	Cayan S, Kadioglu TC, Tefekli A, et al. Comparison of results and complications of high ligation surgery and microsurgical high inguinal varicocelectomy in the treatment of varicocele. Urology, 2000, 55(5): 750-754.
11.	Ghanem H, Anis T, El-Nashar A, et al. Subinguinal microvaricocelectomy versus retroperitoneal varicocelectomy: comparative study of complications and surgical outcome. Urology, 2004, 64(5): 1005-1009.
12.	Riccabona M, Oswald J, Koen M, et al. Optimizing the operative treatment of boys with varicocele: sequential comparison of 4 techniques. J Urol, 2003, 169(2): 666-668.
13.	Cayan S, Acar D, Ulger S, et al. Adolescent varicocele repair: long-term results and comparison of surgical techniques according to optical magnification use in 100 cases at a single university hospital. J Urol, 2005, 174(5): 2003-2006.
14.	Juni P, Altman DG, Egger M. Assessing the quality of controlled clinical trials. BMJ, 2001, 323: 42-46.
15.	Pintus C, Rodriguez Matas MJ, Manzonic C, et al. Varicocele in pediatric patients: comparative assessment of different therapeutic approaches. Urology, 2001, 57: 154-157.
16.	Goldstein M, Gilbert BR, Dicker AP, et al. Microsurgical inguinal varicocelectomy with delivery of the testis: an artery and lymphatic sparing technique. J Urol, 1992, 148(6): 1808-1811.
17.	Cayan S, Akbay E, Bozlu M, et al. Diagnosis of pediatric varicoceles by physical examination and ultrasonography and measurement of the testicular volume using the prader orchidometer versus ultrasonography. Urol Int, 2002, 69: 293.
18.	Watanabe M, Nagai A, Kusumi N, et al. Minimal invasiveness and effectivity of subinguinal microscopic varicocelectomy: a comparative study with retroperitoneal high and laparoscopic approaches. Int J Urol, 2005, 12(10): 892-89.

1. World Health Organization. The influence of varicocele on parameters of fertility in a large group of men presenting to fertility clinics. Fertil Steril, 1992, 57: 1289-1293.
2. 吴阶平. 吴阶平泌尿外科学. 济南: 山东科技出版社, 2004: 1953.
3. Goldstein M, Gilbert BR, Dicker AP, et al. Microsurgical inguinal varicocelectomy with delivery of the testis: an artery and lymphatic sparing technique. J Urol, 1992, 148(6): 1808-1811.
4. Evers JLH , Collins JA. Assessment of efficacy of varicocele repair for male subfertility: a systematic review. Lancet, 2003, 361: 1849.
5. Ficarra V, Cerruto MA, Liguori G, et al. Treatment of Varicocele in Subfertile Men: The Cochrane Review-A Contrary Opinion. Eur Urol, 2006, 49: 258-263.
6. Mulrow CD, Oxman AD. The Cochrane Collaboration handbook, Issue 1, 2000, Oxford, Update Software.
7. Al-Kandari AM, Shabaan H, Ibrahim HM, et al. Comparison of outcomes of different varicocelectomy techniques: open inguinal, laparoscopic, and subinguinal microscopic varicocelectomy: a randomized clinical trial. Urology, 2007, 69(3): 417-420.
8. Al-Said S, Al-Naimi A, Al-Ansari A, et al. Varicocelectomy for Male Infertility: A Comparative Study of Open, Laparoscopic and Microsurgical Approaches. J Urol, 2008, 180(1): 266-270.
9. Barbalias GA, Liatsikos EN, Nikiforidis G, et al. Treatment of varicocele for male infertility: a comparative study evaluating currently used approaches. Eur Urol, 1998, 34(5): 393-398.
10. Cayan S, Kadioglu TC, Tefekli A, et al. Comparison of results and complications of high ligation surgery and microsurgical high inguinal varicocelectomy in the treatment of varicocele. Urology, 2000, 55(5): 750-754.
11. Ghanem H, Anis T, El-Nashar A, et al. Subinguinal microvaricocelectomy versus retroperitoneal varicocelectomy: comparative study of complications and surgical outcome. Urology, 2004, 64(5): 1005-1009.
12. Riccabona M, Oswald J, Koen M, et al. Optimizing the operative treatment of boys with varicocele: sequential comparison of 4 techniques. J Urol, 2003, 169(2): 666-668.
13. Cayan S, Acar D, Ulger S, et al. Adolescent varicocele repair: long-term results and comparison of surgical techniques according to optical magnification use in 100 cases at a single university hospital. J Urol, 2005, 174(5): 2003-2006.
14. Juni P, Altman DG, Egger M. Assessing the quality of controlled clinical trials. BMJ, 2001, 323: 42-46.
15. Pintus C, Rodriguez Matas MJ, Manzonic C, et al. Varicocele in pediatric patients: comparative assessment of different therapeutic approaches. Urology, 2001, 57: 154-157.
16. Goldstein M, Gilbert BR, Dicker AP, et al. Microsurgical inguinal varicocelectomy with delivery of the testis: an artery and lymphatic sparing technique. J Urol, 1992, 148(6): 1808-1811.
17. Cayan S, Akbay E, Bozlu M, et al. Diagnosis of pediatric varicoceles by physical examination and ultrasonography and measurement of the testicular volume using the prader orchidometer versus ultrasonography. Urol Int, 2002, 69: 293.
18. Watanabe M, Nagai A, Kusumi N, et al. Minimal invasiveness and effectivity of subinguinal microscopic varicocelectomy: a comparative study with retroperitoneal high and laparoscopic approaches. Int J Urol, 2005, 12(10): 892-89.

Chinese Journal of Evidence-Based Medicine

Effectiveness and Safety of Microscopic Varicocelectomy versus Palomo Surgery for Varicocele: A Systematic Review

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content