How Can We Predict a Successful Outcome after Varicocelectomy in Painful Varicocele Patients? An Updated Meta-Analysis

PURPOSE: This study evaluated the relationships of varicocele characteristics and surgical methods with the pain resolution rate post-varicocelectomy. MATERIALS AND METHODS: A literature search was conducted using PubMed (MEDLINE) and Embase (1980 to December 2018). The keywords used for the search were “varicocele,” “varicocelectomy OR ligation OR repair,” and “pain OR painful.” Two authors independently reviewed the titles and abstracts of the retrieved articles. Studies were evaluated for eligibility, and those that fulfilled all of the inclusion criteria and none of the exclusion criteria were selected for full-text review. RESULTS: Fourteen studies were included in the analysis. There were no significant differences in the postoperative pain resolution rate with respect to varicocele grades I, II, and III. The resolution rate was significantly higher for dull pain than for dragging and sharp pain (odds ratio [OR], 5.73; 95% confidence interval [CI], 1.78–18.41; p=0.003 and OR, 8.72; 95% CI, 2.91–26.08; p=0.0001, respectively). In terms of the surgical approach, subinguinal ligation was significantly more effective in terms of pain resolution than high ligation (OR, 2.73; 95% CI, 1.54–4.85; p=0.0006). Microsurgical varicocelectomy showed a significantly higher likelihood of pain resolution than laparoscopic varicocelectomy (OR, 7.12; 95% CI, 3.78–13.44; p<0.0001). CONCLUSIONS: Patients with varicocele complaining of dull pain preoperatively had a higher likelihood of postoperative pain resolution than those complaining of dragging or sharp pain. Furthermore, subinguinal ligation was more effective for pain resolution than high ligation, and microsurgical varicocelectomy showed better surgical outcomes than laparoscopic varicocelectomy.