https://doi.org/10.4081/aiua.2023.11627

A systematic review and meta-analysis on the efficacy of internal spermatic artery ligation during laparoscopic varicocelectomy in children and adolescents: Is it safe?

Vol. 95 No. 3 (2023)
Submitted: July 31, 2023
Accepted: August 3, 2023
Published: October 4, 2023
Adolescent, Pediatric andrology, Varicocele, Undescended, Testes, Laparoscopic, Ligation, Testicular artery
Abstract Views: 562
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Authors

Ahmad Nurfakhri Syarief
Department of Urology, Faculty of Medicine, Universitas Airlangga and Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia.
Ilham Akbar Rahman
Department of Urology, Faculty of Medicine, Universitas Airlangga and Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia.
Agung Ravi Saputra Sangadji
Department of Urology, Faculty of Medicine, Universitas Airlangga and Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia.
Tarmono Djojodimedjo
Department of Urology, Faculty of Medicine, Universitas Airlangga and Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia.
Fikri Rizaldi
fikririz@gmail.com
Department of Urology, Faculty of Medicine, Universitas Airlangga and Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia.

Introduction: Challenges in identifying small testicular arteries and lack of microscopic experience have led to a rising trend in the use of laparoscopic technique for pediatric and adolescent varicocele. The controversy over artery ligation (AL) and artery preservation (AP) during laparoscopic varicocelectomy (LV) is still debatable. This study investigates the effectiveness of AL and AP during LV in pediatric and adolescent varicocele cases. Methods: The systematic searches based on PRISMA guideline were conducted in PubMed, Scopus, ScienceDirect, Web of Science and ProQuest databases with pre-defined keywords. Both quantitative and qualitative analyses were performed to assess catch-up growth, persistence, recurrence, hydrocele, operative time, post-operative testicular volume, and sperm analysis. Results: A total of 1512 patients from 9 eligible studies were included. There were no significant differences in catch up growth (OR 0.89; 95%CI 0.53, 1.51; p = 0.68) or hydrocele incidence (OR 0.59; 95%CI 0.28, 1.24; p = 0.16). The recurrence rate and persistence rate in AP group is significantly higher compared to AL group (OR 2.95; 95%CI 1.53, 5.68; p = 0.001 and OR 5.13; 95% CI 2.04, 12.88; p = 0.0005, respectively). The mean operative time during laparoscopic varicocelectomy is significantly longer when arteries are preserved as opposed to when they are ligated (OR 5.33; 95%CI 2.05, 8.60; p = 0.001). AL and AP both improved testicular volume and post-operative sperm analysis. Conclusions: AL showed higher efficacy and comparable safety to AP. We recommend using AL with lymphatic sparing to minimize hydrocele complications.

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How to Cite

Syarief, A. N., Rahman, I. A., Sangadji, A. R. S., Djojodimedjo, T., & Rizaldi, F. (2023). A systematic review and meta-analysis on the efficacy of internal spermatic artery ligation during laparoscopic varicocelectomy in children and adolescents: Is it safe?. Archivio Italiano Di Urologia E Andrologia, 95(3). https://doi.org/10.4081/aiua.2023.11627
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