title: Who will benefit from surgical repair for painful varicocele: a meta-analysis.
abstract: OBJECTIVE
  To determine the efficacy of different surgical approaches and techniques for resolving varicocele-related pain and factors that predict surgical outcomes.
  
  
  METHODS
  The PubMed and Embase databases were searched with the terms "varicocele", "varicocelectomy" and "pain". Manual searches by reviewing the references of included studies were performed. Studies were included when they focused on the influence of varicocele grade, pain quality, different surgical approaches or techniques on pain resolution. A meta-analysis was conducted with RevMan5.3 software.
  
  
  RESULTS
  Twelve studies were identified in the analysis. No significant correlation was found between varicocele grade and pain resolution (P > 0.05). The resolution rate for dull pain was significantly higher than sharp pain [RR = 1.11, 95 % CI (1.02, 1.22), P = 0.02], and there were no other significant differences between the qualities of pain and pain resolution. The pain resolution rate was significantly higher after subinguinal varicocelectomy than after high or inguinal varicocelectomy [RR = 0.83, 95 % CI (0.76, 0.90), P < 0.00001 and RR = 0.92, 95 % CI (0.86, 0.99), P = 0.02]. The pain resolution rate was significantly higher after microsurgery than after laparoscopic varicocelectomy [RR = 0.77, 95 % CI (0.60, 0.99), P = 0.04].
  
  
  CONCLUSIONS
  Subinguinal varicocelectomy and microsurgical varicocelectomy are efficacious for resolving varicocele-related pain compared to other approaches and techniques. Pain quality is a factor that predicts surgical outcomes while varicocele grade is not. Additional controlled studies are warranted to clearly define this clinical problem.
authors.affiliation: Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58, Zhongshan 2nd Road, Guangzhou, 510080, China.
authors.forename: Da-Yu
authors.initials: DY
authors.lastname: Han
authors.affiliation: Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58, Zhongshan 2nd Road, Guangzhou, 510080, China.
authors.forename: Qi-Yun
authors.initials: QY
authors.lastname: Yang
authors.affiliation: Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58, Zhongshan 2nd Road, Guangzhou, 510080, China.
authors.forename: Xu
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Urology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Ouyang
authors.affiliation: Department of Urology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Yao
authors.affiliation: Reproductive Medicine Center, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China.
authors.forename: Gui-Hua
authors.initials: GH
authors.lastname: Liu
authors.affiliation: Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58, Zhongshan 2nd Road, Guangzhou, 510080, China.
authors.forename: Heng
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58, Zhongshan 2nd Road, Guangzhou, 510080, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Xia
authors.affiliation: Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58, Zhongshan 2nd Road, Guangzhou, 510080, China.
authors.forename: Chun-Hua
authors.initials: CH
authors.lastname: Deng
authors.affiliation: Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58, Zhongshan 2nd Road, Guangzhou, 510080, China. sunxzh08@qq.com.
authors.forename: Xiang-Zhou
authors.initials: XZ
authors.lastname: Sun
mesh_terms: D000328:Adult; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D010146:Pain / Q000209:etiology / Q000503:physiopathology*; D010147:Pain Measurement; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014646:Varicocele / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods*
keywords: Metastasis; Pain; Varicocele; Varicocelectomy