Comparing Endovascular and Surgical Treatments for Varicocele: A Systematic Review and Meta-Analysis

Purpose: To conduct a systematic review and meta-analysis to assess the relative efficacy of endovascular and surgical treatments for varicocele. Materials and Methods: PubMed and Embase databases were systematically searched to identify studies reporting on the outcomes associated with surgical or endovascular treatments of varicoceles. The studies that assessed the relative efficacy of surgical and endovascular treatments for patients with clinical varicocele were eligible for inclusion. Pooled data analyses were performed. Results: A total of 16 studies incorporating 2,138 patients were included in the present meta-analysis. The pooled risk ratio (RR) values suggested that rates of adverse events were lower among patients who underwent endovascular treatment than those who underwent surgical treatment (RR, 0.63; 95% confidence interval (CI), 0.42-0.93; P = .02). Both treatments were associated with similar rates of recurrence (RR, 1.03; 95% CI, 0.78-1.36; P = .82) and pregnancy (RR, 1.03; 95% CI, 0.85-1.25; P = .82). Conclusions: These data demonstrate that endovascular treatment for varicocele is associated with similar rates of recurrence and subsequent pregnancy outcomes compared with surgical treatment but with lower rates of adverse events.