| Objective:Varicocele has become the major correctable cause of male infertility which impaired spermatogenesis and testicular function.In recent years,many studies have demonstrated the importance of treatment refers to varicocele in reproductive medicine practice.Several surgical methods could be provided as effective first-line treatment.However there was insufficient evidence to prove that varicocelectomy could help for different age group and complaints.Some cases did not cause any reproductive problems and some of varicocelectomy treatments did not improve the status on male infertility.In order to explore and analyze the risk factors and prognostic predictors of patients of varicocele combined with testicular injure,which could help to choose the proper patients benefit from surgery treament and understanding the mechanism of varicocele induced testicular injures,we designed five parts in our study tried to assist the treatment decision and improve prognosis,to analyze the influence between varicocele and semen parameters and to explore the risk factors of varicocele in testicular injuries.Materials and Methods:Risk factors on semen parameters of varicocele patients.A retrospectively analyzed data of patients with varicocele were collected between 2009.1 and 2017.1 from the urology department of West China Hospital,Sichuan University.Patients were divided into the normal group and the abnormal group according to whether they had impact on semen counts and semen motility.Patients’ clinical characteristics related to varicocele were registered and reproductive injury were evaluated on semen parameters.Predict factors related to testicular damage with statistical significance were calculated using univariate analysis to detect the predictors on testicular damage of varicocele.Prognostic factors on semen parameters of varicocelectomyWe conducted a retrospective study to analyze data of patients with varicocele who received varicocelectomy which collected between 2009.1 and 2017.1 in the urology department of West China Hospital,Sichuan University.Patients’ clinical characteristics related to varicocele were registered and operation effects were evaluated on postoperative semen parameters in three months follow-up.The clinical impact factors related to the improved rate of semen parameters were analyzed by using univariate analysis.Efficacy and safety of different kinds of varicocelectomies:A meta-analysisA systematic review of the relevant randomized clinical trials was performed.Trials were identified from specialized trials register of the Cochrane library and additional electronic searches(mainly MEDLINE,EMBSAE).Clinical trials comparing microsurgical,laparoscopic and open varicocelectomies were included.Statistical analysis was managed using Review Manager 5.3.Prognostic factors on semen parameters of varicocelectomy combined with non-obstructive azoospermia:A systematic review and meta-analysisA literature review was performed to identify all published retrospective trials of the efficacy of varicocelectomy in treatment of patients with non-obstructive azoospermia.Search databases including Pubmed Medline,Embase,Cochrane library,CBMdisc,CNKI,VIP and Wangfang from the founded year to January 2020.Two reviewers independently screened literature,extracted data,and assessed the methodological quality and risk of bias of included studies.The statics analysis was conducted by the software RevMan5.3.Efficacy of antioxidant therapy on sperm quality measurements after varicocelectomy:A systematic review and meta-analysisA literature review was performed to identify all published randomized clinical trials of the efficacy of antioxidant drugs in treatment of patients after varicocelectomy.Search databases including Pubmed Medline,Embase,Cochrane library,CBMdisc,CNKI,VIP and Wangfang from the founded year to October 2020.Two reviewers independently screened literature,extracted data,and assessed the methodological quality and risk of bias of included studies.The statics analysis was conducted by the software RevMan5.3.Results:Risk factors on semen parameters of varicocele patients.Varicocelec patients’data in accordance with the inclusive criteria were evaluated,a total of 388 patients were eventually calculated and 53(13.6%)patients found a loss in parameters of sperm concentration with a mean semen concentration 73.2±44.6x106/ml.And 378(97.4%)patients damaged on sperm motility parameters with a mean value 33.3±13.6%.There was no difference between varicocele group and healthy group.The semen counts abnormal group patients related to older age(OR=0.45,P=0.04)and the semen motility abnormal group ones related to higher NLR number(OR=0.54,P=0.02)。.The difference was statistically significant.Prognostic factors on semen parameters of varicocelectomyVaricocelectomy patients’ data in accordance with the inclusive criteria were evaluated and included,a total of 135 patients were eventually calculated 79(58.5%)patients improved the parameters of sperm concentration in 15%after surgery with a mean semen concentration 73.2±44.6x106/ml,having significant difference compared with preoperative parameter.And 66(48.9%)patients achieved 15%improvement rate on sperm motility parameters with a mean value 33.3±13.6%,also have statistical difference compared before.After surgery,the semen counts benefit group patients related to a better baseline testicular function(OR=2.87,P<0.01);(OR=2.81,P<0.01).The semen motility benefit group related to younger patients(OR=0.18,P<0.01)and worse baseline semen motility(OR=0.54,P<0.01).Efficacy and safety of different kinds of varicocelectomies:A meta-analysisTen clinical trials of 2,025 patients were included.The meta-analysis indicated that compared with open varicocelectomy,microsurgery had a higher pregnancy rate(OR=0.61,95%CI[0.45,0.84],p=0.002),while there was nonsignificant difference between microsurgical and laparoscopic varicocelectomies or between laparoscopic and open varicocelectomies.Both microsurgical and laparoscopic varicocelectomies had a greater increase in postoperative sperm concentration than open varicocelectomy(MD=-3.75,95%CI[-5.3 1,-2.20],p<0.00001)and(MD=-7.17,95%CI[-11.85,-2.48],p=0.003),respectively).Microsurgical varicocelectomy also showed better improvement in postoperative sperm motility(MD=-9.06,95%CI[-15.22,-2.90],p=0.004).Compared with the other two,microsurgical varicocelectomy had the longest operative time(MD=-25.54,95%CI[-40.82-10.25],p=0.001).A nonsignificant difference was found in the hospital stay between the three approaches,whereas microsurgical(MD=1.59,95%CI[0.81,2.37],p<0.0001)and laparoscopic varicocelectomies(MD=0.97,95%CI[0.34,1.60],p=0.002)had a shorter time to return to work.Moreover,microsurgical varicocelectomy had a lower incidence of postoperative complications(OR=4.62,95%CI[2.3 1,9.22],p<0.0001)and recurrence(OR=6.14,95%CI[2.85,13.24],p<0.00001)compared with the others.Prognostic factors on semen parameters of varicocelectomy combined with non-obstructive azoospermia:A systematic review and meta-analysis18 eligible reports were identified including 609 cases.The Meta-analysis outcomes showed that the probability of successful varicocele repair was significantly greater for patients with hypospermatogenesis or maturation arrest than for those with Sertoli-cell-only(OR=16.96,CI[8.64,33.29],P<0.01).And patients with late maturation arrest had a greater probability of success than those with early maturation arrest(OR=8.62,CI[2.41,30.80],P<0.01).Efficacy of antioxidant therapy on sperm quality measurements after varicocelectomy:A systematic review and meta-analysisSeven eligible reports were identified including 605 cases.The Meta-analysis results showed that the adjuvant antioxidant drugs improved the change of sperm density(MD=9.18x106/ml;95%CI:6.83-11.52;P<0.00001),change of sperm motility(MD=8.35%;95%CI:3.22-13.49;P=0.001)and change of sperm morphology(MD=6.81;95%CI:0.32-3.31;P=0.04)after varicocele surgery in three month time.there is no statistical difference for antioxidant drugs in changing the sperm density(MD=12.37x106/ml;95%CI:-0.30-5.03;P=0.06)and sperm motility(MD=8.35%;95%CI:3.22-3.49;P=0.001)after operation in six months but the change of sperm morphology(MD=5.21;95%CI:2.16-.26;P=0.0008).Conclusion:Varicocele could induced a loss in semen parameter and the elevated NLR and older age patients were likely to combined with testicular injuries.Semen parameters could benefit from surgery treament.The slight testicular injuries might be helpful to the recover of semen counts,and younger patients could be more benefit of semen motility.Analysis of current evidence shows that microsurgical varicocelectomy has a longer operative time,lower incidence of postoperative complications,and recurrence than laparoscopic and open varicocelectomies,and shows a higher pregnancy rate,with a greater increase in postoperative sperm concentration,better improvement in postoperative sperm motility,and shorter time to return to work than open varicocelectomy.Tesiticular biopsies could be the prognostic factors on the semen parameters of non-obstructive azoospermia patients after varicocelectomy.The antioxidant drugs supplementation could improve the semen parameters after varicocelectomy in three month time,but there was little evidence for long-time efficacy which need more research help to prove it. |
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