Surgical efficacy and predictors of outcome in varicocelectomy: a meta-analysis of multivariable studies

Varicocele is a common cause of male infertility. Varicocelectomy can effectively improve semen quality, but it does not improve semen quality in all patients.

Prior to conducting this meta-analysis, we registered the protocol in PROSPERO (CRD42024574608). Our meta-analysis by searching databases such as Web of Science, Embase, PubMed, and Cochrane Library. Only studies utilizing multivariable logistic regression were included. Odds ratios (OR) with 95% confidence intervals (CI) were calculated to assess the effect size.

The analysis comprised 11 studies with 1,498 patients and encompassed 14 outcomes. The overall efficacy rate of varicocelectomy was 62.8% (95% CI 55.6-69.9%). Compared to other surgical methods and approaches, microsurgical varicocelectomy and subinguinal varicocelectomy demonstrated higher surgical efficacy rates. Higher preoperative sperm concentration (OR = 1.04, 95% CI 1.01-1.06) and total motile sperm count (OR = 3.00, 95% CI 1.04-8.67) were predictive of better post-varicocelectomy outcomes. Furthermore, a positive correlation existed between wider spermatic vein diameter and improved efficacy post-varicocelectomy (OR = 2.41, 95% CI 1.36-4.26).

Microsurgical subinguinal varicocelectomy achieves higher surgical efficacy rates. Varicocele patients with better preoperative sperm concentration, total motile sperm count, and wider spermatic vein diameter are more likely to benefit from varicocelectomy. This provides andrologists with a reference basis for advising varicocele patients on the surgical efficacy and potential benefits post-varicocelectomy.