Comparison of sclero-embolization and surgical ligation for varicocele treatment: a systematic review and...

Varicocele is characterized by abnormally dilated and tortuous veins in the pampiniform plexus. Treatment options are varied, including open surgery, laparoscopic surgery, microscopic varicocelectomy, and sclero-embolization. However, no consensus exists on the optimal treatment. This systematic review and meta-analysis aim to compare the effectiveness and safety of sclero-embolization versus surgical ligation for varicocele.

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically searched PubMed, Web of Science, EMBASE, and MEDLINE for relevant studies up to October 14, 2023. Study selection followed the Patient, Intervention, Comparison, Outcome, Study type (PICOS) framework. The quality of included studies was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies and the Cochrane Risk of Bias Tool (CCTARB) for randomized controlled trials. Data analysis was performed using Review Manager (RevMan) version 5.4.

Thirty studies were included in the final analysis. Regarding recurrence rates, sclero-embolization was associated with a statistically higher recurrence rate compared to high ligation (OR = 1.37, 95% CI 1.03-1.82, p = 0.03). For sperm concentration, a non-significant trend favoring sclero-embolization was observed (MD = 7.09, 95% CI -0.14 to 14.31, p = 0.05). Sclero-embolization demonstrated a more favorable safety profile, with lower overall complication rates (OR = 0.65, 95% CI 0.47-0.91, p = 0.01) and significantly reduced incidence of hydrocele (OR = 0.19, 95% CI 0.10-0.35, p < 0.00001) compared to surgical ligation.

This meta-analysis reveals a nuanced trade-off between sclero-embolization and surgical ligation for varicocele treatment. Sclero-embolization is associated with higher recurrence rates but a more favorable safety profile, while its effect on sperm concentration remains marginal and inconclusive. Surgical ligation, particularly the high ligation approach, demonstrates superior efficacy in preventing recurrence but carries a higher risk of complications. The choice of technique should therefore be individualized based on patient-specific factors. These findings warrant validation through further high-quality, prospective studies.