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Does Varicocele Repair Improve Conventional Semen Parameters? a Meta-Analytic Study of Before-After Data Publisher



Cannarella R1, 2 ; Shah R3 ; Aboalmagd Abdelmeguid Hamoda T4, 5 ; Boitrelle F6, 7 ; Saleh R8 ; Gul M9 ; Rambhatla A10 ; Kavoussi P11 ; Toprak T12 ; Harraz AM13, 14, 15 ; Ko E16 ; Ceker G17 ; Durairajanayagam D18 ; Alkahidi N19 Show All Authors
Authors
  1. Cannarella R1, 2
  2. Shah R3
  3. Aboalmagd Abdelmeguid Hamoda T4, 5
  4. Boitrelle F6, 7
  5. Saleh R8
  6. Gul M9
  7. Rambhatla A10
  8. Kavoussi P11
  9. Toprak T12
  10. Harraz AM13, 14, 15
  11. Ko E16
  12. Ceker G17
  13. Durairajanayagam D18
  14. Alkahidi N19
  15. Kuroda S2, 20
  16. Crafa A1
  17. Henkel R21, 22
  18. Salvio G23
  19. Hazir B24
  20. Darbandi M25, 26
  21. Bendayan M6, 7
  22. Darbandi S25, 26
  23. Falcone M27
  24. Garrido N28
  25. Kosgi R29
  26. Kaiyal RS2
  27. Karna K30
  28. Ho Vinh Phuoc N31, 32
  29. Birowo P33
  30. Colpi GM34
  31. De La Rosette J35
  32. Pinggera GM36
  33. Nguyen Q37, 38
  34. Zini A39
  35. Zohdy W40
  36. Singh R41
  37. Saini P42
  38. Glina S43
  39. Lin H44
  40. Mostafa T40
  41. Rojascruz C45
  42. Arafa M40, 46, 47, 48
  43. Calogero AE1
  44. Dimitriadis F49
  45. Kothari P50
  46. Karthikeyan VS51
  47. Okada K52
  48. Chiba K52
  49. Kadioglu A53
  50. Altay B54
  51. Turunc T55
  52. Zilaitiene B56
  53. Gokalp F57
  54. Adamyan A58
  55. Katz D59, 60, 61
  56. Chung E62
  57. Mierzwa TC43
  58. Zylbersztejn DS63
  59. Paul GM64
  60. Sofikitis N65
  61. Sokolakis I66
  62. Malhotra V67
  63. Brodjonegoro SR68
  64. Adriansjah R69
  65. Tsujimura A70
  66. Amano T71
  67. Balercia G23
  68. Ziouziou I72
  69. Deswanto IA73
  70. Martinez M74
  71. Park HJ75, 76
  72. Bakircioglu ME77
  73. Ceyhan E78
  74. Aydos K79
  75. Ramsay J80
  76. Minhas S81
  77. Hashimi MA82, 83
  78. Ghayda RA84
  79. Tadros N85
  80. Sindhwani P86
  81. Ho CCK87
  82. Rachman RI33
  83. Pena MR88
  84. Motawi A40
  85. Ponnusamy AK89
  86. Dipankar S90
  87. Amir A91
  88. Binsaleh S92
  89. Serefoglu EC93
  90. Banthia R94
  91. Khalafalla K47, 95, 96
  92. Basukarno A97
  93. Bac NH98
  94. Singla K99
  95. Ambar RF43, 100
  96. Makarounis K101
  97. Priyadarshi S102
  98. Kusuma Duarsa GW103
  99. Atmoko W33
  100. Jindal S104
  101. Arianto E105
  102. Akhavizadegan H106
  103. Bardisi HE47, 48
  104. Shoshany O107
  105. Busetto GM108
  106. Moussa M109
  107. Jamali M110
  108. Almarhoon MS111
  109. Ruzaev M112
  110. Farsi HMA4
  111. Mutambirwa S113
  112. Lee DS114
  113. Kulaksiz D115
  114. Cheng YS116
  115. Bouzouita A117
  116. Sarikaya S118
  117. Kandil H119
  118. Tsampoukas G120
  119. Alaa F121
  120. Bowa K122
  121. Savira M33
  122. Mogharabian N123
  123. Le TV31
  124. Harjanggi M124
  125. Anh DT125
  126. Tien Long TQ126
  127. Soebadi MA127
  128. Hakim L128
  129. Tanic M129
  130. Ari UC130
  131. Parikh FR131
  132. Calik G35
  133. Vinod KV132
  134. Dorji G133
  135. Rezano A134, 135
  136. Rajmil O136
  137. Ba Tien DM31
  138. Yuan Y44
  139. Lizarragasalas JF137
  140. Eze B138
  141. Ngoo KS139
  142. Lee J140
  143. Arslan U12
  144. Agarwal A122, 141
Show Affiliations
Authors Affiliations
  1. 1. Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
  2. 2. Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
  3. 3. Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
  4. 4. Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
  5. 5. Department of Urology, Faculty of Medicine, Minia University, Minia, Egypt
  6. 6. Department of Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France
  7. 7. Department of Biology, Reproduction, Epigenetics, Environment and Development, Paris Saclay University, UVSQ, INRAE, BREED, Jouy-en-Josas, France
  8. 8. Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
  9. 9. Department of Urology, Selcuk University School of Medicine, Konya, Turkey
  10. 10. Department of Urology, Henry Ford Health System, Vattikuti Urology Institute, Detroit, MI, United States
  11. 11. Department of Reproductive Urology, Austin Fertility & Reproductive Medicine, Westlake IVF, Austin, TX, United States
  12. 12. Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
  13. 13. Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
  14. 14. Department of Surgery, Urology Unit, Farwaniya Hospital, Farwaniya, Kuwait
  15. 15. Department of Urology, Sabah Al Ahmad Urology Center, Kuwait City, Kuwait
  16. 16. Department of Urology, Loma Linda University Health, Loma Linda, CA, United States
  17. 17. Department of Urology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
  18. 18. Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia
  19. 19. Department of Internal Medicine, Trinity Health/Mercy Health, Muskegon, MI, United States
  20. 20. Department of Urology, Reproduction Center, Yokohama City University Medical Center, Yokohama, Japan
  21. 21. Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
  22. 22. Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa
  23. 23. Department of Endocrinology, Polytechnic University of Marche, Ancona, Italy
  24. 24. Reproductive Medicine, Clinical Research Centre, Lund University, Malmo, Sweden
  25. 25. Fetal Health Research Center, Hope Generation Foundation, Tehran, Iran
  26. 26. Gene Therapy and Regenerative Medicine Research Center, Hope Generation Foundation, Tehran, Iran
  27. 27. Department of Urology, Molinette Hospital, A.O.U. Citta della Salute e della Scienza, University of Turin, Torino, Italy
  28. 28. IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigacion Sanitaria La Fe (IIS La Fe), Valencia, Spain
  29. 29. Department of Urology, Andrology and Renal Transplant, AIG Hospitals, Hyderabad, India
  30. 30. Department of Molecular Cell and Cancer Biology, University of Massachusetts Medical School, Worcester, MA, United States
  31. 31. Department of Andrology, Binh Dan Hospital, Ho Chi Minh, Viet Nam
  32. 32. Department of Urology and Andrology, Pham Ngoc Thach University of Medicine, Ho Chi Minh, Viet Nam
  33. 33. Department of Urology, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
  34. 34. Andrology and IVF Center, Next Fertility Procrea, Lugano, Switzerland
  35. 35. Department of Urology, Istanbul Medipol Mega University Hospital, Istanbul, Turkey
  36. 36. Department of Urology, Innsbruck Medical University, Innsbruck, Austria
  37. 37. Center for Andrology and Sexual Medicine, Viet Duc University Hospital, Hanoi, Viet Nam
  38. 38. Department of Urology, Andrology and Sexual Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam
  39. 39. Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada
  40. 40. Department of Andrology, Sexology & STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
  41. 41. Central Drug Research Institute, Male Reproductive Health Research Laboratory, Uttar Pradesh, Lucknow, India
  42. 42. Division of Endocrinology, Central Drug Research Institute, Lucknow, India
  43. 43. Division of Urology, Centro Universitario FMABC, Santo Andre, Brazil
  44. 44. Department of Urology, Peking University Third Hospital, Peking University, Beijing, China
  45. 45. Department of Urology, University Hospital of Rostock, Rostock, Germany
  46. 46. American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, United States
  47. 47. Department of Urology, Hamad Medical Corporation, Doha, Qatar
  48. 48. Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar
  49. 49. Department of Urology, Aristotle University School of Medicine, Thessaloniki, Greece
  50. 50. Department of Urology, Topiwala National Medical College, B.Y.L Nair Ch Hospital, Mumbai, India
  51. 51. Andrology Unit, Department of Urology, Apollo Hospitals, Greams Road, Chennai, India
  52. 52. Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
  53. 53. Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
  54. 54. Department of Urology, Ege University, Izmir, Turkey
  55. 55. Urocentre Urology Clinic, Adana, Turkey
  56. 56. Institute of Endocrinology, Lithuanian University of Health Sciences, Kaunas, Lithuania
  57. 57. Department of Urology, Faculty of Medicine, Hatay Mustafa Kemal University, Hatay, Antakya, Turkey
  58. 58. Department of Urology, Astghik Medical Center, Yerevan, Armenia
  59. 59. Men’s Health Melbourne, VIC, Australia
  60. 60. Department of Surgery, Western Precinct, University of Melbourne, VIC, Australia
  61. 61. Department of Urology, Western Health, VIC, Australia
  62. 62. Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
  63. 63. Fleury Group, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
  64. 64. Department of Clinical Surgery, Health Sciences Sector, the Federal University of Parana (UFPR), Parana, Curitiba, Brazil
  65. 65. Department of Urology, Ioannina University School of Medicine, Ioannina, Greece
  66. 66. Department of Urology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
  67. 67. SCM Clinic and Hospital, New Delhi, India
  68. 68. Division of Urology, Department of Surgery, Prof. Dr. Sardjito Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia
  69. 69. Department of Urology, Hasan Sadikin Hospital, Medical Faculty of Padjadjaran University, Bandung, Indonesia
  70. 70. Department of Urology, Juntendo University Urayasu Hospital, Chiba, Japan
  71. 71. Department of Urology, Nagano Red Cross Hospital, Nagano, Japan
  72. 72. Department of Urology, College of Medicine and Pharmacy, Ibn Zohr University, Agadir, Morocco
  73. 73. Elang Medika Corpora Hospital, Tangerang, Indonesia
  74. 74. Section of Urology, Department of Surgery, University of Santo Tomas Hospital, Manila, Philippines
  75. 75. Department of Urology, Pusan National University School of Medicine, Busan, South Korea
  76. 76. Medical Research Institute of Pusan National University Hospital, Busan, South Korea
  77. 77. SENSART Clinic, Istanbul, Turkey
  78. 78. Department of Urology, Baskent University Faculty of Medicine, Ankara, Turkey
  79. 79. Department of Urology, Ankara University School of Medicine, Ankara, Turkey
  80. 80. Department of Andrology, Hammersmith Hospital, Imperial, London, United Kingdom
  81. 81. Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom
  82. 82. Department of Urology, Burjeel Hospital, Abu Dhabi, United Arab Emirates
  83. 83. Clinical Urology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
  84. 84. Institute of Urology, University Hospitals, Case Western Reserve University, Cleveland, OH, United States
  85. 85. Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, United States
  86. 86. Department of Urology, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, United States
  87. 87. Department of Surgery, School of Medicine, Taylor’s University, Selangor, Subang Jaya, Malaysia
  88. 88. Instituto de Ginecologia y Fertilidad (IFER) y Universidad Barcelo, Buenos Aires, Argentina
  89. 89. AndroOne Men’s Health Clinic, Salem, India
  90. 90. Department of Physiology, All India Institute of Medical Sciences, Mangalagiri, Mangalagiri, India
  91. 91. Department of Urology, Dr Wahidin Sudirohusodo Hospital, Makassar, Indonesia
  92. 92. Division of Urology, Department of Surgery, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
  93. 93. Department of Urology, Biruni University School of Medicine, Istanbul, Turkey
  94. 94. Department of Urology, Western General Hospital, Edinburgh, United Kingdom
  95. 95. Urology Department, University of Texas McGovern Medical School, Houston, TX, United States
  96. 96. Department of Urology, MD Anderson Cancer Center, Houston, TX, United States
  97. 97. Department of Urology, Dr. Dradjat Hospital, Serang, Indonesia
  98. 98. Department of Andrology and Sexual Medicine, Hanoi Medical University’s Hospital, Hanoi, Viet Nam
  99. 99. Clarity Health, Chandigarh, India
  100. 100. Andrology Department, Ideia Fertil Institute, Santo Andre, Sao Paulo, Brazil
  101. 101. Department of Urology and Andrology, Locus Medicus, Athens, Greece
  102. 102. Department of Urology, Sawai Man Singh Medical College and Hospital, Rajasthan, Jaipur, India
  103. 103. Department of Urology, Prof. Dr. I.G.N.G Ngoerah General Hospital, Faculty of Medicine, Universitas Udayana, Bali, Indonesia
  104. 104. Department of Andrology & Reproductive Medicine, Jindal Hospital & Fertility Center, Meerut, India
  105. 105. Department of Urology, Prof R.D. Kandou Hospital, Manado, Indonesia
  106. 106. Urology Department, Tehran University of Medical Scienes, Tehran, Iran
  107. 107. Department of Urology, University of Illinois at Chicago, Chicago, IL, United States
  108. 108. Department of Urology and Renal Transplantation, Univeristy of Foggia, Foggia, Italy
  109. 109. Department of Urology, Lebanese University, Beirut, Lebanon
  110. 110. Department of Urology, Military Teaching Hospital, Rabat, Morocco
  111. 111. Department of Surgery, Urology Division, Sultan Qaboos University, Muscat, Oman
  112. 112. Urology Clinic, Moscow, Russian Federation
  113. 113. Department of Urology, Dr. George Mukhari Academic Hospital, Sefako Makgatho Health Science University, Medunsa, Ga-Rankuwa, South Africa
  114. 114. Department of Urology, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, South Korea
  115. 115. Department of Obstetrics and Gynecology, University of Health Sciences, Kanuni Training and Research Hospital, Trabzon, Turkey
  116. 116. Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  117. 117. Department of Anatomy, Faculty of Medicine, Faculty Tunis Manar, Tunis, Tunisia
  118. 118. Department of Urology, Gulhane Research and Training Hospital, University of Health Sciences, Ankara, Turkey
  119. 119. Fakih IVF Fertility Center, Abu Dhabi, United Arab Emirates
  120. 120. Department of Urology, Oxford University Hospital, Oxford, United Kingdom
  121. 121. Global Andrology Forum, Moreland Hills, OH, United States
  122. 122. Department of Urology, School of Medicine and Health Sciences, University of Lusaka, Lusaka, Zambia
  123. 123. Sexual Health and Fertility Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
  124. 124. IVF Jakarta - YPK Mandiri, Jakarta, Indonesia
  125. 125. Tam Anh IVF Center, Tam Anh General Hospital, Hanoi, Viet Nam
  126. 126. Department of Obstetrics and Gynecology, Hanoi Obstetric and Gynecology Hospital, Hanoi, Viet Nam
  127. 127. Department of Urology, Soetomo Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
  128. 128. Department of Urology, Universitas Airlangga Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
  129. 129. Department of Urology, General Hospital, Cuprija, Serbia
  130. 130. Department of Reproduction and Artificial Insemination, Faculty of Veterinary Medicine, Kafkas University, Kars, Turkey
  131. 131. FertilTree-Jaslok International Fertility Centre, Jaslok Hospital, Maharashtra, Mumbai, India
  132. 132. Cure & SK Hospital, Trivandrum, India
  133. 133. Department of Anatomy, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
  134. 134. Andrology Study Program, Department of Biomedical Sciences, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
  135. 135. Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, West Java, Sumedang, Indonesia
  136. 136. Department of Andrology, Fundacio Puigvert, Barcelona, Spain
  137. 137. Instituto de Ciencias en Reproduccion Humana Vida, Leon, Mexico
  138. 138. Department of Surgery, College of Medicine, Enugu State University of Science and Technology, Enugu, Nigeria
  139. 139. Urology Unit, Department of Surgery, Hospital Angkatan Tentera Tuanku Mizan, Kuala Lumpur, Malaysia
  140. 140. Department of Urology, National University Hospital, Singapore
  141. 141. Cleveland Clinic, Cleveland, OH, United States

Source: World Journal of Men's Health Published:2023


Abstract

Purpose: 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. Materials and Methods: 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). Results: 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. Conclusions: 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. © 2023 World J Mens Healt. All rights reserved.
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