Effects of Varicocele Repair on Testicular Endocrine Function: A Systematic Review and Meta-Analysis.

IF 4 3区 医学 Q1 ANDROLOGY
Rossella Cannarella, Rupin Shah, Edmund Ko, Parviz Kavoussi, Amarnath Rambhatla, Taha Abo-Almagd Abdel-Meguid Hamoda, Ramadan Saleh, Ahmed M Harraz, Aldo E Calogero, Damayanthi Durairajanayagam, Tuncay Toprak, Gokhan Calik, Andrea Crafa, Sezgin Gunes, Nazim Gherabi, Shinnosuke Kuroda, Hussein Kandil, Murat Gül, Florence Boitrelle, Ramy Abou Ghayda, Raghavender Kosgi, Vilvapathy Senguttuvan Karthikeyan, Giorgio I Russo, Selahittin Cayan, Rajender Singh, Eric Chung, Carlo Giulioni, Gian Maria Busetto, Ashok Agarwal
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引用次数: 0

Abstract

Purpose: The objective of this manuscript is to assess the effect of varicocele repair (VR) in patients with clinical varicoceles on serum total testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and inhibin B serum levels.

Materials and methods: The study was performed in compliance with the Meta-Analysis and Systematic Reviews of Observational Studies (MOOSE) guidelines and the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). All eligible studies were selected following the PICOS (Population, Intervention, Comparison/Comparator, Outcomes, Study design) model. The values of each outcome measured after VR were compared to the before parameters and, when available, to the values on patients with unrepaired varicocele, and to those of healthy controls with no varicocele. For total testosterone, the values were sub-analyzed based on the mean total testosterone levels before VR (<300 ng/dL or >300 ng/dL), the fertility status, the time of follow-up and the technique used for VR.

Results: From a total of 460 abstracts retrieved, 48 articles were included in our meta-analysis. Serum total testosterone levels were significantly higher after VR compared to both pre-treatment levels (mean difference [MD] 82.45 ng/dL, 95% confidence interval [CI]: 64.14-100.76; p<0.00001) and to the levels of patients with unrepaired varicocele (MD 91.64 ng/dL, 95% CI: 62.30-120.99; p<0.00001). They did not differ from the levels of healthy controls with no varicocele (MD -22.01 ng/dL, 95% CI: -68.59-24.58; p=0.35). The increase resulted to be independent from the mean total testosterone levels before VR, fertility status, time of follow-up and type of VR. After VR, a trend toward lower serum LH levels was found compared to before values (MD -0.37 IU/L, 95% CI: -0.74-0.01; p=0.06). When compared to the levels of patients with unrepaired VR, LH levels after VR were significantly lower (MD -0.96 IU/L, 95% CI: -1.56 to -0.35; p=0.002). LH levels were not significantly higher than healthy men without varicocele (MD 0.84 IU/L, 95% CI: -0.68-2.36; p=0.28). Patients with VR had significantly lower FSH levels compared to their pre-treatment values (MD -1.43 IU/L, 95% CI: -1.82 to -1.04; p<0.00001), and also to those of patients with non-repaired varicocele (MD -2.35 IU/L, 95% CI: -4.06 to -0.65; p=0.007). When compared to healthy controls with no varicocele, FSH levels were significantly higher (MD 2.71 IU/L, 95% CI: 1.12-4.31; p=0.0009). Lastly, after VR no significant change in inhibin B serum levels was seen compared to pre-treatment levels (MD 11.76 pg/mL, 95% CI: -3.83-27.35; p=0.14).

Conclusions: The present meta-analysis is the largest to date to assess the impact of VR on Leydig cell and Sertoli cell function using a before-after analysis for uncontrolled studies, and using data from patients with unrepaired varicoceles or healthy patients without varicocele as controls. VR was found to increase and restore to normality serum levels of total testosterone and LH. This evidence could be of value in considering the treatment of varicocele in patients with low testosterone or those who show a progressive decline in testosterone levels.

精索静脉曲张修复术对睾丸内分泌功能的影响:系统回顾与元分析》。
目的:本手稿旨在评估临床精索静脉曲张患者进行精索静脉曲张修复术(VR)对血清总睾酮、促黄体生成素(LH)、促卵泡激素(FSH)和抑制素B血清水平的影响:本研究遵照观察性研究的元分析和系统综述(MOOSE)指南以及系统综述和元分析协议的首选报告项目(PRISMA-P)进行。所有符合条件的研究均按照 PICOS(人群、干预、比较/比较者、结果、研究设计)模型进行筛选。VR 后测量的各项结果值均与 VR 前的参数进行了比较,如果有的话,还与未修复精索静脉曲张患者的值以及未患精索静脉曲张的健康对照组的值进行了比较。对于总睾酮,则根据VR前的平均总睾酮水平(300 ng/dL)、生育状况、随访时间和VR技术对数值进行了细分分析:在检索到的 460 篇摘要中,有 48 篇文章被纳入荟萃分析。与治疗前相比,VR 后血清总睾酮水平明显升高(平均差 [MD] 82.45 ng/dL,95% 置信区间 [CI]:64.14-100.76;pConclusions):本荟萃分析是迄今为止规模最大的一次荟萃分析,它采用了对无对照研究进行前后分析的方法,并使用了未修复精索静脉曲张患者或无精索静脉曲张的健康患者的数据作为对照,评估了VR对精原细胞和Sertoli细胞功能的影响。研究发现,精索静脉曲张能增加血清总睾酮和促性腺激素的水平,并使其恢复正常。这一证据对于考虑治疗睾酮过低或睾酮水平逐渐下降的精索静脉曲张患者很有价值。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
World Journal of Mens Health
World Journal of Mens Health Medicine-Psychiatry and Mental Health
CiteScore
7.60
自引率
2.10%
发文量
92
审稿时长
6 weeks
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