Introduction: Many factors hinder a positive response to varicocelectomy on semen parameters, and varicocele recurrence is considered a common factor. Because of the higher risks of a redo procedure, recurrent varicocele has been treated less frequently. However, many recent reports have shown a benefit for a redo procedure, specially the open microsurgical technique.
The aim is to evaluate the role of redo procedure for recurrent varicocele on male fertility potential by evaluating the postoperative changes in semen parameters, hormonal profile and pregnancy rate.
Methods: 32 eligible patients with recurrent varicocele who underwent redo microsurgical varicocelectomy at out center were included in the chart review. Pre- and post-operative semen parameters and hormone profile results were analyzed.
A literature systemic review was also performed following the PRISMA guidelines. Databases were searched using the appropriate keywords. Articles reporting at least one semen parameter, hormonal levels or pregnancy rate were included.
A total of 8 articles were identified and included. 4 used micro surgical redo varicocelectomy, 2 radiological embolization, one open retroperitoneal and one laparoscopic ligation. A meta-analysis was executed using the comprehensive meta-analysis software and included the searched studies along with this current report (n=9).
Results: In our retrospective study, a significant post-operative improvement in sperm concentration P = 0.031, progressive motility P = 0.038, total motile sperm count (TMSC) P = 0.05, and normal morphology P= 0.03 was observed. While an increase in total motility did not reach statistical significance.
Meta-analysis revealed a significant improvement in sperm concentration in 5 studies with an increase of 20.28 million/ml. Total motility was reported by 5 articles and showed a significant improvement by 9.66%. Progressive motility was only reported by 2 articles, results showed a statistically not significant improvement. Morphology was reported by 3 articles and showed a significant improvement by 4.46%. TMSC was reported by 4 studies and also displayed a significant improvement of 23.26 million. spontaneous pregnancy rate was reported in 6 studies with a rate of 34.5%. No significant changes were noted in the hormone results both in this original report and in the meta-analysis.
Conclusions: Procedures for recurrent varicocele are beneficial, they result in improvement in semen parameters and might improve pregnancy outcome and avoid the risks associated with ART.