The purpose of this meta-analysis is to study the impact of varicocele repair in the largest cohort of infertile males with clinical varicocele by including all available studies, with no language restrictions, comparing intra-person conventional semen parameters before and after the repair of varicoceles.
The meta-analysis was performed according to PRISMA-P and MOOSE guidelines. A systematic search was performed in Scopus, PubMed, Cochrane, and Embase databases. Eligible studies were selected according to the PICOS model (Population: infertile male patients with clinical varicocele; Intervention: varicocele repair; Comparison: intra-person before-after varicocele repair; Outcome: conventional semen parameters; Study type: randomized controlled trials [RCTs], observational and case-control studies).
Out of 1,632 screened abstracts, 351 articles (23 RCTs, 292 observational, and 36 case-control studies) were included in the quantitative analysis. The before-and-after analysis showed significant improvements in all semen parameters after varicocele repair (except sperm vitality); semen volume: standardized mean difference (SMD) 0.203, 95% CI: 0.129-0.278; p<0.001; I²=83.62%, Egger's p=0.3329; sperm concentration: SMD 1.590, 95% CI: 1.474-1.706; p<0.001; I²=97.86%, Egger's p<0.0001; total sperm count: SMD 1.824, 95% CI: 1.526-2.121; p<0.001; I²=97.88%, Egger's p=0.0063; total motile sperm count: SMD 1.643, 95% CI: 1.318-1.968; p<0.001; I²=98.65%, Egger's p=0.0003; progressive sperm motility: SMD 1.845, 95% CI: 1.537%-2.153%; p<0.001; I²=98.97%, Egger's p<0.0001; total sperm motility: SMD 1.613, 95% CI 1.467%-1.759%; p<0.001; l2=97.98%, Egger's p<0.001; sperm morphology: SMD 1.066, 95% CI 0.992%-1.211%; p<0.001; I²=97.87%, Egger's p=0.1864.
The current meta-analysis is the largest to date using paired analysis on varicocele patients. In the current meta-analysis, almost all conventional semen parameters improved significantly following varicocele repair in infertile patients with clinical varicocele.
The world journal of men's health. 2023 Jun 22 [Epub ahead of print]
Rossella Cannarella, Rupin Shah, Taha Abo-Almagd Abdel-Meguid Hamoda, Florence Boitrelle, Ramadan Saleh, Murat Gul, Amarnath Rambhatla, Parviz Kavoussi, Tuncay Toprak, Ahmed M Harraz, Edmund Ko, Gökhan Çeker, Damayanthi Durairajanayagam, Noora Alkahidi, Shinnosuke Kuroda, Andrea Crafa, Ralf Henkel, Gianmaria Salvio, Berk Hazir, Mahsa Darbandi, Marion Bendayan, Sara Darbandi, Marco Falcone, Nicolas Garrido, Raghavender Kosgi, Raneen Sawaid Kaiyal, Keshab Karna, Nguyen Ho Vinh Phuoc, Ponco Birowo, Giovanni M Colpi, Jean de la Rosette, Germar-Michael Pinggera, Quang Nguyen, Armand Zini, Wael Zohdy, Rajender Singh, Pallavi Saini, Sidney Glina, Haocheng Lin, Taymour Mostafa, Cesar Rojas-Cruz, Mohamed Arafa, Aldo E Calogero, Fotios Dimitriadis, Priyank Kothari, Vilvapathy Senguttuvan Karthikeyan, Keisuke Okada, Koji Chiba, Ates Kadıoglu, Baris Altay, Tahsin Turunc, Birute Zilaitiene, Fatih Gokalp, Aram Adamyan, Darren Katz, Eric Chung, Tiago Cesar Mierzwa, Daniel Suslik Zylbersztejn, Gustavo Marquesine Paul, Nikolaos Sofikitis, Ioannis Sokolakis, Vineet Malhotra, Sakti Ronggowardhana Brodjonegoro, Ricky Adriansjah, Akira Tsujimura, Toshiyasu Amano, Giancarlo Balercia, Imad Ziouziou, Isaac Ardianson Deswanto, Marlon Martinez, Hyun Jun Park, Mustafa Emre Bakırcıoglu, Erman Ceyhan, Kaan Aydos, Jonathan Ramsay, Suks Minhas, Manaf Al Hashimi, Ramy Abou Ghayda, Nicholas Tadros, Puneet Sindhwani, Christopher C K Ho, Rinaldo Indra Rachman, Marcelo Rodriguez Pena, Ahmad Motawi, Arun Karthik Ponnusamy, Satish Dipankar, Azwar Amir, Saleh Binsaleh, Ege Can Serefoglu, Ravi Banthia, Kareim Khalafalla, Ari Basukarno, Nguyen Hoai Bac, Karun Singla, Rafael F Ambar, Konstantinos Makarounis, Shivam Priyadarshi, Gede Wirya Kusuma Duarsa, Widi Atmoko, Sunil Jindal, Eko Arianto, Hamed Akhavizadegan, Haitham El Bardisi, Ohad Shoshany, Gian Maria Busetto, Mohamad Moussa, Mounir Jamali, Mohamed S Al-Marhoon, Mikhail Ruzaev, Hasan M A Farsi, Shingai Mutambirwa, Dong Sup Lee, Deniz Kulaksiz, Yu-Sheng Cheng, Abderrazak Bouzouita, Selcuk Sarikaya, Hussein Kandil, Georgios Tsampoukas, Ala'a Farkouh, Kasonde Bowa, Missy Savira, Nasser Mogharabian, Tan V Le, Maruto Harjanggi, Dang Tuan Anh, Tran Quang Tien Long, Mohammad Ayodhia Soebadi, Lukman Hakim, Marko Tanic, Umut Cagin Ari, Firuza R Parikh, Gokhan Calik, Vinod Kv, Gyem Dorji, Andri Rezano, Osvaldo Rajmil, Dung Mai Ba Tien, Yiming Yuan, Juan Francisco Lizarraga-Salas, Balantine Eze, Kay Seong Ngoo, Joe Lee, Umut Arslan, Ashok Agarwal, Global Andrology Forum
Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy., Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India., Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia., Department of Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France., Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt., Department of Urology, Selcuk University School of Medicine, Konya, Turkey., Department of Urology, Henry Ford Health System, Vattikuti Urology Institute, Detroit, MI, USA., Department of Reproductive Urology, Austin Fertility & Reproductive Medicine/Westlake IVF, Austin, TX, USA., Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey., Urology and Nephrology Center, Mansoura University, Mansoura, Egypt., Department of Urology, Loma Linda University Health, Loma Linda, CA, USA., Department of Urology, Ba\xc5\x9fak\xc5\x9fehir Cam and Sakura City Hospital, Istanbul, Turkey., Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia., Department of Internal Medicine, Trinity Health/Mercy Health, Muskegon, MI, USA., Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA., Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK., Department of Endocrinology, Polytechnic University of Marche, Ancona, Italy., Reproductive Medicine, Clinical Research Centre, Lund University, Malmö, Sweden., Fetal Health Research Center, Hope Generation Foundation, Tehran, Iran., Department of Urology, Molinette Hospital, A.O.U. 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of Andrology, Sexology & STIs, Faculty of Medicine, Cairo University, Cairo, Egypt., Central Drug Research Institute, Male Reproductive Health Research Laboratory, Lucknow, Uttar Pradesh, India., Division of Endocrinology, Central Drug Research Institute, Lucknow, India., Division of Urology, Centro Universitario FMABC, Santo André, Brazil., Department of Urology, Peking University Third Hospital, Peking University, Beijing, China., Department of Urology, University Hospital of Rostock, Rostock, Germany., Department of Urology, Aristotle University School of Medicine, Thessaloniki, Greece., Department of Urology, Topiwala National Medical College, B.Y.L Nair Ch Hospital, Mumbai, India., Andrology Unit, Department of Urology, Apollo Hospitals, Greams Road, Chennai, India., Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan., Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey., Department of Urology, Ege University, 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Urology, Western General Hospital, Edinburgh, UK., Department of Urology, Hamad Medical Corporation, Doha, Qatar., Department of Urology, Dr. Dradjat Hospital, Serang, Indonesia., Department of Andrology and Sexual Medicine, Hanoi Medical University's Hospital, Hanoi, Vietnam., Clarity Health, Chandigarh, India., Department of Urology and Andrology, Locus Medicus, Athens, Greece., Department of Urology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India., Department of Urology, Prof. Dr. I.G.N.G Ngoerah General Hospital, Faculty of Medicine, Universitas Udayana, Bali, Indonesia., Department of Andrology & Reproductive Medicine, Jindal Hospital & Fertility Center, Meerut, India., Department of Urology, Prof R.D. 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