The Influence of Number of Ligated Veins in Varicocele Patients Undergoing Microsurgical Varicocelectomy in Postoperative Pain and Sperm Parameters Outcome

BACKGROUND: The influence of the number of veins that should be ligated in varicocele surgery on postoperative pain and testicular function is not clearly understood. OBJECTIVE: The aim of this study was to investigate the number of Internal Spermatic Vein (ISV) ligated in postoperative pain and sperm parameters outcome. METHODS: Relevant studies were collected and systematically reviewed from Medline, Scopus, and Cochrane databases. This study followed the PRISMA guideline. The mean difference (MD), odds ratio (OR), and 95% confidence intervals (CIs) were measured in the assessment of the outcome. Revman 5.4 was used in data analysis. RESULTS: The pooled meta-analysis demonstrated that complete pain resolution was significantly higher in patients undergoing varicocelectomy procedures with more than ten vein numbers ligated with OR 1.92, 95% CI (1.03, 3.60). Improvement of sperm parameters of change in sperm concentration was also significantly observed in patients with more than ten vein numbers ligated MD 32.79, 95% CI (23.13, 42.45). However, the number of veins ligated was not associated with the change in sperm motility MD 9.69 with 95% CI (-12.32, 31.71). CONCLUSION: The number of veins ligated intraoperatively determined pain relief and sperm concentration improvement. This study showed that varicocelectomy results improved with greater ISV ligation.