背景:持续或精索静脉曲张复发治疗后的结局和发病率仍存在争议。
目的:对精索静脉曲张持续性/复发治疗(任何手术或放射学)后的结果进行系统评价。
方法:根据系统评价和荟萃分析陈述的首选报告项目进行系统评价。纳入前瞻性和回顾性观察性或介入性研究,直至2022年3月。结果是怀孕率,与基线相比,治疗后精液参数有所改善,疼痛控制,并发症发生率,和重复治疗方法。包括患有任何等级持续性/复发性精索静脉曲张的任何年龄的男性。
结果:在确定的913篇文章中,18名1073名患者符合纳入条件。第一次和重复治疗之间的平均时间在5.3和73.3个月之间。重复治疗的适应症是18项研究中的8项不孕症和6项疼痛控制,而4人没有提供适应症的细节.在最初使用放射学干预治疗的复发性/持续性精索静脉曲张患者中,83.8%接受了另一个放射学程序,而16.2%接受了外科手术。在最初接受外科手术治疗的患者中,77.8%的人接受了进一步的外科手术,而22.2%接受了放射学程序。重复治疗的成功率为60-100%。报告的并发症如下:鞘膜积液(高达16%),睾丸萎缩(高达2%),阴囊血肿(高达1.6%),伤口感染(高达6.6%),慢性疼痛(高达2.9%),对其他器官的伤害(高达10%),和血栓性静脉炎(高达5.8%)。疼痛控制的症状缓解率>90%。12个月随访时,妊娠率为17-58%。在87.5%的研究中,与基线相比,重复治疗后精液参数有所改善。根据纽卡斯尔和渥太华量表,主要限制是偏见的高风险,纳入研究的异质性,和小简单的尺寸。
结论:治疗任何级别的持续性/复发性精索静脉曲张均具有良好的成功率,怀孕,和疼痛控制,但仍有并发症的风险。用相同的介入方式重复治疗是可行的。证据水平总体较低。
结果:在这篇关于持续性或复发性精索静脉曲张的系统综述中,我们证明用放射学或外科手术重复治疗是可行的,取得了良好的成功,怀孕,和随访时的疼痛控制率。然而,重复治疗与首次干预患者相关的已发表文献中报道的并发症风险较高.
BACKGROUND: The outcomes and morbidity following treatment for persistent or varicocele recurrence remain controversial.
OBJECTIVE: To conduct a systematic
review relating to the outcomes following treatment (any surgical or radiological) for varicocele persistence/recurrence.
METHODS: A systematic
review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Prospective and retrospective observational or interventional studies were included until March 2022. Outcomes were pregnancy rate, improvements in semen parameters after treatment compared with those at baseline, pain control, complication rates, and repeat treatment approach. Men of any age with any-grade persistent/recurrent varicoceles were included.
RESULTS: Of 913 articles identified, 18 with 1073 patients were eligible for inclusion. The mean time between the first and repeat treatment ranged between 5.3 and 73.3 months. The indication for repeat treatment was infertility in eight and pain control in six out of 18 studies, whereas four did not provide details for the indication. Of the patients with recurrent/persistent varicoceles initially treated using a radiological intervention, 83.8% underwent another radiological procedure, whereas 16.2% underwent a surgical procedure. Of those initially treated with a surgical procedure, 77.8% underwent a further surgical procedure, whereas 22.2% underwent a radiological procedure. The rate of success of repeat treatment was 60-100%. The reported complications were as follows: hydrocele (up to 16%), testicular atrophy (up to 2%), scrotal hematoma (up to 1.6%), wound infection (up to 6.6%), chronic pain (up to 2.9%), injury to other organs (up to 10%), and thrombophlebitis (up to 5.8%). The rate of symptom resolution was >90% for pain control. Pregnancy rates were 17-58% at 12-month follow-up. Semen parameters improved after repeat treatment compared with that at baseline in 87.5% of studies. The main limitations are the high risk of bias according to the Newcastle and Ottawa Scale, heterogeneity of the included studies, and small simple size.
CONCLUSIONS: Treating any grade of persistent/recurrent varicoceles has a good rate of success, pregnancy, and pain control, but there is still a risk of complications. Repeat treatment with the same interventional modality is feasible. The level of evidence is overall low.
RESULTS: In this systematic
review on persistent or recurrent varicoceles, we showed that repeat treatment with radiological or surgical procedures was feasible, with good success, pregnancy, and pain control rates at follow-up. However, repeat treatment was associated with a higher risk of complications than reported in the published literature relating to patients having their first intervention.