TY - JOUR
T1 - Effects of Varicocele Repair on Sperm DNA Fragmentation and Seminal Malondialdehyde Levels in Infertile Men with Clinical Varicocele
T2 - A Systematic Review and Meta-Analysis
AU - Cannarella, Rossella
AU - Shah, Rupin
AU - Saleh, Ramadan
AU - Boitrelle, Florence
AU - Hamoda, Taha Abo Almagd Abdel Meguid
AU - Singh, Rajender
AU - Salvio, Gianmaria
AU - Toprak, Tuncay
AU - Falcone, Marco
AU - Gul, Murat
AU - Dimitriadis, Fotios
AU - Rambhatla, Amarnath
AU - Russo, Giorgio I.
AU - Ko, Edmund
AU - Zini, Armand
AU - Kavoussi, Parviz
AU - Phuoc, Nguyen Ho Vinh
AU - Kandil, Hussein
AU - Ghayda, Ramy Abou
AU - Birowo, Ponco
AU - Gherabi, Nazim
AU - Ceyhan, Erman
AU - Dong, Jie
AU - Malhotra, Vineet
AU - Durairajanayagam, Damayanthi
AU - Kolbasi, Bircan
AU - Bahar, Fahmi
AU - Calik, Gokhan
AU - Çayan, Selahittin
AU - Pinggera, Germar Michael
AU - Calogero, Aldo E.
AU - Rajmil, Osvaldo
AU - Mostafa, Taymour
AU - Atmoko, Widi
AU - Harraz, Ahmed M.
AU - Le, Tan V.
AU - de la Rosette, Jean
AU - Hakim, Lukman
AU - Pescatori, Edoardo
AU - Sergeyev, Oleg
AU - Rashed, Ayman
AU - Saini, Pallavi
AU - Agarwal, Ashok
N1 - Publisher Copyright:
© 2024 Korean Society for Sexual Medicine and Andrology. All rights reserved.
PY - 2024/4
Y1 - 2024/4
N2 - Purpose: Varicoceles can be a source of elevated seminal oxidative stress (OS) and sperm DNA fragmentation (SDF). However, it remains unclear whether varicocele repair (VR) could reduce these parameters. This systematic review and meta-analysis (SRMA) aims to investigate the impact of VR on SDF and seminal malondialdehyde (MDA). Materials and Methods: A literature search was performed in Scopus, PubMed, Ovid, Embase, and Cochrane databases. This SRMA included randomized controlled trials and observational studies reporting the pre- and postoperative levels of SDF and seminal OS in infertile men with clinical varicocele that underwent VR. Subgroup analyses included techniques of VR and SDF testing. The effect size was expressed as standardized mean difference (SMD). Results: Out of 1,632 abstracts assessed for eligibility, 29 studies with 1,491 infertile men were included. The analysis showed a significant reduction in SDF after VR, compared to preoperative values (SMD -1.125, 95% confidence interval [CI] -1.410, -0.840; p<0.0001) with high inter-study heterogeneity (I2=90.965%). Reduction in SDF was evident with microsurgical technique and non-microsurgical inguinal approaches (SMD -1.014, 95% CI -1.263, -0.765; p<0.0001, and SMD -1.495, 95% CI -2.116, -0.873; p<0.0001), respectively. Reduction in SDF was significant irrespective of testing was done by sperm chromatin dispersion (SMD -2.197, 95% CI -3.187, -1.207; p<0.0001), sperm chromatin structure assay (SMD -0.857, 95% CI -1.156, -0.559; p<0.0001) or TUNEL (SMD -1.599, 95% CI -2.478, -0.719; p<0.0001). A significant decrease in seminal MDA levels was observed following VR (SMD -2.450, 95% CI -3.903 to -0.997, p=0.001) with high inter-study heterogeneity (I2=93.7%). Conclusions: Using pre- and post-intervention data, this SRMA indicates a significant reduction in SDF and seminal MDA levels in infertile men with clinical varicocele treated with VR. These findings may have important implications for the future management of this selected group of infertile patients.
AB - Purpose: Varicoceles can be a source of elevated seminal oxidative stress (OS) and sperm DNA fragmentation (SDF). However, it remains unclear whether varicocele repair (VR) could reduce these parameters. This systematic review and meta-analysis (SRMA) aims to investigate the impact of VR on SDF and seminal malondialdehyde (MDA). Materials and Methods: A literature search was performed in Scopus, PubMed, Ovid, Embase, and Cochrane databases. This SRMA included randomized controlled trials and observational studies reporting the pre- and postoperative levels of SDF and seminal OS in infertile men with clinical varicocele that underwent VR. Subgroup analyses included techniques of VR and SDF testing. The effect size was expressed as standardized mean difference (SMD). Results: Out of 1,632 abstracts assessed for eligibility, 29 studies with 1,491 infertile men were included. The analysis showed a significant reduction in SDF after VR, compared to preoperative values (SMD -1.125, 95% confidence interval [CI] -1.410, -0.840; p<0.0001) with high inter-study heterogeneity (I2=90.965%). Reduction in SDF was evident with microsurgical technique and non-microsurgical inguinal approaches (SMD -1.014, 95% CI -1.263, -0.765; p<0.0001, and SMD -1.495, 95% CI -2.116, -0.873; p<0.0001), respectively. Reduction in SDF was significant irrespective of testing was done by sperm chromatin dispersion (SMD -2.197, 95% CI -3.187, -1.207; p<0.0001), sperm chromatin structure assay (SMD -0.857, 95% CI -1.156, -0.559; p<0.0001) or TUNEL (SMD -1.599, 95% CI -2.478, -0.719; p<0.0001). A significant decrease in seminal MDA levels was observed following VR (SMD -2.450, 95% CI -3.903 to -0.997, p=0.001) with high inter-study heterogeneity (I2=93.7%). Conclusions: Using pre- and post-intervention data, this SRMA indicates a significant reduction in SDF and seminal MDA levels in infertile men with clinical varicocele treated with VR. These findings may have important implications for the future management of this selected group of infertile patients.
KW - DNA fragmentation
KW - Infertility
KW - male
KW - Malondialdehyde
KW - Varicocele
UR - http://www.scopus.com/inward/record.url?scp=85189533509&partnerID=8YFLogxK
U2 - 10.5534/wjmh.230235
DO - 10.5534/wjmh.230235
M3 - Article
AN - SCOPUS:85189533509
SN - 2287-4208
VL - 42
SP - 321
EP - 337
JO - World Journal of Men's Health
JF - World Journal of Men's Health
IS - 2
ER -
