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Abstract：
OBJECTIVE: Varicoceles can be a source of elevated seminal oxidative stress (OS) and sperm DNA fragmentation (SDF). However, it remains unclear whether varicocele repair (VR) could reduce these parameters. This systematic review and meta-analysis (SRMA) aims to investigate the impact of VR on SDF and seminal malondialdehyde (MDA).
METHODS: A literature search was performed in Scopus, PubMed, Ovid, Embase, and Cochrane databases. This SRMA included randomized controlled trials and observational studies reporting the pre- and postoperative levels of SDF and seminal OS in infertile men with clinical varicocele that underwent VR. Subgroup analyses included techniques of VR and SDF testing. The effect size was expressed as standardized mean difference (SMD).
RESULTS: Out of 1,632 abstracts assessed for eligibility, 29 studies with 1,491 infertile men were included. The analysis showed a significant reduction in SDF after VR, compared to preoperative values (SMD -1.125, 95% confidence interval [CI] -1.410, -0.840; p<0.0001) with high inter-study heterogeneity (I²=90.965%). Reduction in SDF was evident with microsurgical technique and non-microsurgical inguinal approaches (SMD -1.014, 95% CI -1.263, -0.765; p<0.0001, and SMD -1.495, 95% CI -2.116, -0.873; p<0.0001), respectively. Reduction in SDF was significant irrespective of testing was done by sperm chromatin dispersion (SMD -2.197, 95% CI -3.187, -1.207; p<0.0001), sperm chromatin structure assay (SMD -0.857, 95% CI -1.156, -0.559; p<0.0001) or TUNEL (SMD -1.599, 95% CI -2.478, -0.719; p<0.0001). A significant decrease in seminal MDA levels was observed following VR (SMD -2.450, 95% CI -3.903 to -0.997, p=0.001) with high inter-study heterogeneity (I²=93.7%).
CONCLUSIONS: Using pre- and post-intervention data, this SRMA indicates a significant reduction in SDF and seminal MDA levels in infertile men with clinical varicocele treated with VR. These findings may have important implications for the future management of this selected group of infertile patients.
METHODS: A literature search was performed in Scopus, PubMed, Ovid, Embase, and Cochrane databases. This SRMA included randomized controlled trials and observational studies reporting the pre- and postoperative levels of SDF and seminal OS in infertile men with clinical varicocele that underwent VR. Subgroup analyses included techniques of VR and SDF testing. The effect size was expressed as standardized mean difference (SMD).
RESULTS: Out of 1,632 abstracts assessed for eligibility, 29 studies with 1,491 infertile men were included. The analysis showed a significant reduction in SDF after VR, compared to preoperative values (SMD -1.125, 95% confidence interval [CI] -1.410, -0.840; p<0.0001) with high inter-study heterogeneity (I²=90.965%). Reduction in SDF was evident with microsurgical technique and non-microsurgical inguinal approaches (SMD -1.014, 95% CI -1.263, -0.765; p<0.0001, and SMD -1.495, 95% CI -2.116, -0.873; p<0.0001), respectively. Reduction in SDF was significant irrespective of testing was done by sperm chromatin dispersion (SMD -2.197, 95% CI -3.187, -1.207; p<0.0001), sperm chromatin structure assay (SMD -0.857, 95% CI -1.156, -0.559; p<0.0001) or TUNEL (SMD -1.599, 95% CI -2.478, -0.719; p<0.0001). A significant decrease in seminal MDA levels was observed following VR (SMD -2.450, 95% CI -3.903 to -0.997, p=0.001) with high inter-study heterogeneity (I²=93.7%).
CONCLUSIONS: Using pre- and post-intervention data, this SRMA indicates a significant reduction in SDF and seminal MDA levels in infertile men with clinical varicocele treated with VR. These findings may have important implications for the future management of this selected group of infertile patients.
摘要：
目的：精索静脉曲张可能是精液氧化应激（OS）和精子DNA断裂（SDF）升高的来源。然而,目前尚不清楚精索静脉曲张修复术(VR)是否能降低这些参数.本系统综述和荟萃分析（SRMA）旨在研究VR对SDF和精液丙二醛（MDA）的影响。
方法：在Scopus进行了文献检索，PubMed,奥维德,Embase,和Cochrane数据库。该SRMA包括随机对照试验和观察性研究，报告了接受VR的临床精索静脉曲张的不育男性患者术前和术后的SDF和精浆OS水平。亚组分析包括VR和SDF测试技术。效应大小表示为标准化平均差(SMD)。
结果：在评估资格的1,632份摘要中，包括29项研究，包括1,491名不育男性。分析表明，VR后SDF显着降低，与术前值（SMD-1.125，95％置信区间[CI]-1.410，-0.840;p<0.0001）相比，研究间异质性高（I²=90.965％）。通过显微外科技术和非显微外科腹股沟入路，SDF明显减少（SMD-1.014，95％CI-1.263，-0.765;p<0.0001，和SMD-1.495，95％CI-2.116，-0.873;p<0.0001），分别。无论是否通过精子染色质分散进行测试，SDF的降低都是显着的（SMD-2.197，95％CI-3.187，-1.207；p<0.0001），精子染色质结构测定(SMD-0.857,95%CI-1.156,-0.559;p<0.0001)或TUNEL(SMD-1.599,95%CI-2.478,-0.719;p<0.0001)。在VR（SMD-2.450，95％CI-3.903至-0.997，p=0.001）后，精液MDA水平显着下降，研究间异质性很高（I²=93.7％）。
结论：使用干预前后的数据，该SRMA表明接受VR治疗的临床精索静脉曲张不育男性中SDF和精浆MDA水平显着降低。这些发现可能对这组不育患者的未来管理具有重要意义。
方法：在Scopus进行了文献检索，PubMed,奥维德,Embase,和Cochrane数据库。该SRMA包括随机对照试验和观察性研究，报告了接受VR的临床精索静脉曲张的不育男性患者术前和术后的SDF和精浆OS水平。亚组分析包括VR和SDF测试技术。效应大小表示为标准化平均差(SMD)。
结果：在评估资格的1,632份摘要中，包括29项研究，包括1,491名不育男性。分析表明，VR后SDF显着降低，与术前值（SMD-1.125，95％置信区间[CI]-1.410，-0.840;p<0.0001）相比，研究间异质性高（I²=90.965％）。通过显微外科技术和非显微外科腹股沟入路，SDF明显减少（SMD-1.014，95％CI-1.263，-0.765;p<0.0001，和SMD-1.495，95％CI-2.116，-0.873;p<0.0001），分别。无论是否通过精子染色质分散进行测试，SDF的降低都是显着的（SMD-2.197，95％CI-3.187，-1.207；p<0.0001），精子染色质结构测定(SMD-0.857,95%CI-1.156,-0.559;p<0.0001)或TUNEL(SMD-1.599,95%CI-2.478,-0.719;p<0.0001)。在VR（SMD-2.450，95％CI-3.903至-0.997，p=0.001）后，精液MDA水平显着下降，研究间异质性很高（I²=93.7％）。
结论：使用干预前后的数据，该SRMA表明接受VR治疗的临床精索静脉曲张不育男性中SDF和精浆MDA水平显着降低。这些发现可能对这组不育患者的未来管理具有重要意义。
