Comparing the efficacy of different embolisation materials in improving pain and fertility outcomes in patients with varicoceles: A systematic review
Corresponding Author
Daniel Kasunic
Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
Correspondence
Daniel Kasunic, Royal Prince Alfred Hospital, PO Box M157, Missenden Road, Sydney, NSW 2050, Australia.
Email: [email protected]
Search for more papers by this authorMitchell Crebert
Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
Search for more papers by this authorPatrick-Julien Treacy
Urology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
Search for more papers by this authorDaniel Steffens
Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
Search for more papers by this authorSascha Karunaratne
Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
Search for more papers by this authorRichard Waugh
Radiology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
Search for more papers by this authorRuban Thanigasalam
Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
Urology Department, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
Search for more papers by this authorScott Leslie
Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
Urology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
Search for more papers by this authorCorresponding Author
Daniel Kasunic
Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
Correspondence
Daniel Kasunic, Royal Prince Alfred Hospital, PO Box M157, Missenden Road, Sydney, NSW 2050, Australia.
Email: [email protected]
Search for more papers by this authorMitchell Crebert
Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
Search for more papers by this authorPatrick-Julien Treacy
Urology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
Search for more papers by this authorDaniel Steffens
Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
Search for more papers by this authorSascha Karunaratne
Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
Search for more papers by this authorRichard Waugh
Radiology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
Search for more papers by this authorRuban Thanigasalam
Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
Urology Department, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
Search for more papers by this authorScott Leslie
Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
Urology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
Search for more papers by this authorD Kasunic: MD; M Crebert MD; P-J Treacy MD; D Steffens PhD; S Karunaratne MPhty; R Waugh MBBS, FRANZCR; R Thanigasalam MBBS, MS, FRACS; S Leslie MBBS, MPhil, FRACS.
Abstract
Radiological embolisation has emerged as a safe and effective alternative to surgery for varicocele treatment. While systematic reviews have compared embolisation to surgery, attempts to compare different embolisation materials have been limited. The objective was to conduct a systematic review assessing the potential benefits of combining coils with sclerosants for varicocele embolisation on fertility, pain, recurrence and complication rates in male patients, as compared to using coils alone. The search was conducted through MEDLINE, Embase and CENTRAL databases from inception to May 2023. Comparative studies that reported male varicocele patients treated with embolisation using either coils or coils with sclerosants were included, with primary outcomes of either fertility, pain or recurrence. Pearling of reference lists was also performed to identify additional articles. Risk of bias for each study was assessed using the Downs and Black Checklist. Overall, 21 studies (2236 patients) were included. Patients were treated with coils in 14 studies, and nine studies used coils with sclerosants. An improvement in sperm concentration and motility was identified post-embolisation in most studies that reported these outcomes. Pregnancy and recurrence rates were comparable between the two materials. All four studies that reported pain outcomes following embolisation noted improvement in pain scores. Only one comparative study was included, for recurrence. This review has identified improvements in pain and fertility following varicocele embolisation. However, it could not be determined which material was superior due to the lack of high-quality comparative studies in the literature.
Open Research
Data availability statement
Data sharing is not applicable to this article as no new data were created or analyzed in this study.
Supporting Information
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