Varicocele Influence On Youth And The Treatment Effect

Objective:To systematly analysiz the influence of varicocele on young patients, and observe the curative effect of two surgical methods for treatment of young patients with varicocele by testicular volume, semen quality, hormone level and clinical symptoms.Methods:The First part, by searching PubMed, Medline, Cochrane library and Chinese biomedical literature database(CBM) in young patients with varicocele related literature, evaluating the effect of varicocele in young patients. The key words use the terms "varicocele; youth; adolescent; adolescent" both in English and Chinese. Study selection, data collection, analyses and assessment were undertaken by two reviewers independently. Different views of two reviewers were solved by discussion or consult experts.The data retrieved documents Meta was analyzed by Rev Man5.0 software.The second part: Comparing therapeutic effect between Microscopic and Laparoscopic Approach in young Varicocelectomy.We retrospectively analyzed 71 adolescence varicocele patients whose treatment follow-up data. 39 cases underwent laparoscopic high ligation of spermatic vein(laparoscopic group,LV), 32 patients received ligation of varicocele group under the microscope(microscopy group,MV). Comparing semen quality, hormone levels, testicular volume, operation time, hospitalization days, hospitalization expenses and Visual pain score(VAS) of two group which preoperation and postoperation.Result:The first part:A total of 1415 potentially relevant studies were found through combined research. After screening all titles and abstracts, 11 articles fulfilled the inclusion criteria. The eleven studies included in this systematic review involved 389 Varicocele patients and 459 controls. Compared with control group, the sperm density, sperm motility and sperm morphology of varicocele group was obviously reduced(P, respectively 0.004,0.004,0.0006). The second part: Compared with microscope groupoperation time of laparoscopic group is obviously shortened(85.94 + 20.44 VS 39.00 + 9.69, P < 0.05), but the hospitalization expenses was significantly increased(4866 + 541.45 VS 7820 + 906.21, P<0.05).The days of hospitalization of both group is no difference(P > 0.05). Semen volume in postoperation of 2 groups compared with preoperation was no statistically significant difference,but sperm density, sperm survival rate, A+B grade sperm significantly improved(P<0.05). In the laparoscopic group, 2 cases(5.1%) recurrence, 1 cases(2.6%) was complicated with epididymitis, 2 cases(5.1%) Symptom was no obvious improvement and 2 cases(5.1%) was complicated with scrotal edema; However, Microscope group had no recurrence, scrotal edema, epididymitis. But symptoms of 1 patient(3.1%) did not significantly improve. Compared with the laparoscopic group, the VAS score of microscope group was lower at 1 week after operation(P < 0.01).Conclusion: The first part:This meta-analysis shows that varicocele can significantly reduce sperm density, the rate of normal sperm morphology and sperm activity rate. However, surgery can significantly improve sperm density, sperm morphology and motility. The second part: Early operation can restore the semen quality. Laparoscopic and microscope treatment in varicocele were minimally invasive operation, small trauma, good curative effect. Moreover cost, recurrence rate and complications in microscope group was lower.