Trends for Surgical Treatment of Testicular Varicocele: A German Whole-population Analysis of Inpatient Procedures from 2006 to 2021

IF 3.2 3区医学 Q1 UROLOGY & NEPHROLOGY

European Urology Open Science Pub Date : 2025-03-28 DOI:10.1016/j.euros.2025.03.001

Cem Aksoy , Philipp Reimold , Philipp Karschuck , Subhajit Mandal , Nicole Eisenmenger , Christer Groeben , Aristeidis Zacharis , Johannes Huber , Luka Flegar

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Abstract

Background and objective

Testicular varicocele (TVC) is a common benign finding in men of all ages. Indications for TVC repair are abnormal sperm parameters and testicular pain. The optimal surgical method for TVC repair is still a matter of controversy. The aim of our study was to analyze the current situation and trends for TVC surgery in Germany.

Methods

The German reports for hospital quality were analyzed from 2006 to 2021. Linear regression models were applied to detect trends over time. Outpatient procedure rates were estimated.

Key findings and limitations

A total of 38 653 inpatient TVC surgeries were included. Total varicocelectomy procedures decreased from 3456 in 2006 to 2165 in 2021 (−37.4%; p < 0.001). The proportion of open TVC procedures remained constant at ∼25%. The proportion of laparoscopic TVC procedures increased from 25% in 2006 to 45% in 2021 (p < 0.001), while the sclerotherapy rate for TVC treatment decreased from 47% in 2006 to 29% in 2021 (p < 0.001). In 2006, 543 hospitals offered TVC treatment, which decreased to 466 hospitals in 2021 (−14.2%). Among patients undergoing surgical TVC procedures in 2021, 75% were younger than 35 yr. We estimated an increase in outpatient procedures from 365 cases in 2013 to 1330 cases in 2021 (p < 0.001). The estimation for outpatient procedures represents a study limitation.

Conclusions and clinical implications

Laparoscopic TVC treatment is the dominant surgical approach. However, one in three patients receives sclerotherapy for TVC in Germany. While fewer hospitals offer the treatment, we observed a trend for centralization, with an increase in high-caseload departments, as well as an increasing trend for outpatient treatment.

Patient summary

TVC is a collection of swollen veins in the testicle. We analyzed treatment trends in Germany for this condition from 2006 to 2021. There was an increase in the use of keyhole surgery over time, and we estimate that the percentage of day-case surgeries also increased.

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睾丸精索静脉曲张的手术治疗趋势：2006年至2021年德国住院手术的全人群分析

背景与目的睾丸精索静脉曲张（TVC）是所有年龄段男性常见的良性病变。TVC修复的适应症是精子参数异常和睾丸疼痛。TVC修复的最佳手术方法仍有争议。我们研究的目的是分析德国TVC手术的现状和趋势。方法对2006 ~ 2021年德国医院质量报告进行分析。线性回归模型用于检测随时间变化的趋势。估计门诊手术率。主要发现和局限性共纳入38653例住院TVC手术。精索静脉曲张切除术总数从2006年的3456例下降到2021年的2165例(−37.4%；p & lt;0.001)。开放TVC手术的比例保持在25%不变。腹腔镜TVC手术的比例从2006年的25%增加到2021年的45% (p <；0.001)，而TVC治疗的硬化治疗率从2006年的47%下降到2021年的29% (p <；0.001)。2006年，543家医院提供TVC治疗，到2021年减少到466家医院（- 14.2%）。在2021年接受外科TVC手术的患者中，75%的患者年龄小于35岁。我们估计门诊手术从2013年的365例增加到2021年的1330例(p <；0.001)。门诊手术的估计存在研究局限性。结论及临床意义腹腔镜是治疗TVC的主要手术方式。然而，在德国，三分之一的TVC患者接受硬化治疗。虽然提供这种治疗的医院越来越少，但我们观察到一种集中的趋势，即高病例负荷部门的增加，以及门诊治疗的增加趋势。tvc是睾丸内肿胀静脉的集合。我们分析了2006年至2021年德国对这种疾病的治疗趋势。随着时间的推移，锁眼手术的使用有所增加，我们估计日间手术的比例也有所增加。

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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