title: The role of testicular artery in laparoscopic varicocelectomy: a systematic review and meta-analysis.
abstract: OBJECTIVE
  We performed this meta-analysis to evaluate the efficacy and safety of artery preserving versus artery non-preserving in laparoscopic varicocelectomy.
  
  
  METHODS
  All publications up until October 2015 were searched in PubMed, EMBASE, Ovid, Web of Science, and Cochrane library. Randomized controlled trials (RCTs) and cohort studies (CSs) that compared the difference in two operative approaches in laparoscopic varicocelectomy were included. Statistical analysis was performed using Stata version 12.0.
  
  
  RESULTS
  A total of four RCTs and ten CSs involving 503 cases with artery preserving and 911 cases with artery non-preserving met our inclusion criteria. Meta-analysis showed that artery preserving had higher recurrence rate [risk ratio (RR) = 2.91, 95 % confidence interval (CI) 1.83-4.61; P = 0.000], lower incidence of hydrocele formation (RR = 0.18; 95 % CI 0.08-0.42; P = 0.000), and prolonged operating time [standard mean difference (SMD) = 1.27; 95 % CI 0.17-2.37; P = 0.023], compared with artery non-preserving in laparoscopic varicocelectomy. The results were similar in postoperative catch-up growth (RR = 1.00; 95 % CI 0.86-1.17; P = 0.985) and testicular atrophy (RR = 0.36; 95 % CI 0.09-1.54; P = 0.169). Besides, no significant difference was found in sperm concentration, motility, and normal morphology between two groups, as well as on postoperative pregnancy rate (RR = 0.95; 95 % CI 0.65-1.40; P = 0.809).
  
  
  CONCLUSIONS
  With the advantages of less recurrence, easier operating and less time spending, and comparable results in other respects, artery non-preserving is preferable to artery preserving in laparoscopic varicocelectomy, although there is a relatively high incidence of hydrocele formation. Considering the limitation of included studies, more large-scaled RCTs are required to confirm the present findings.
authors.affiliation: Department of Urology, Subei People's Hospital, No. 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China.|Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China.
authors.forename: Xiaokang
authors.initials: X
authors.lastname: Qi
authors.affiliation: Department of Urology, The First People's Hospital of Lianyungang City, No. 182 North Tongguan Road, Xinpu District, Lianyungang, 222002, Jiangsu, China.
authors.forename: Kunpeng
authors.initials: K
authors.lastname: Wang
authors.affiliation: Department of Urology, Subei People's Hospital, No. 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China.
authors.forename: Guangchen
authors.initials: G
authors.lastname: Zhou
authors.affiliation: Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Xu
authors.affiliation: Department of Urology, Subei People's Hospital, No. 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China.
authors.forename: Junjie
authors.initials: J
authors.lastname: Yu
authors.affiliation: Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China. zhangwei@medmail.com.cn.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
mesh_terms: D006801:Humans; D010535:Laparoscopy; D008297:Male; D013737:Testis / Q000098:blood supply*; D014646:Varicocele / Q000601:surgery*
keywords: Laparoscopic varicocelectomy; Meta-analysis; Recurrence; Testicular artery; Varicocele