A Systematic Review and Meta-analysis of the Efficacy of Intraoperative Vascular Doppler Ultrasonography for Vein Ligations and Artery Preservations in Microsurgical Subinguinal Varicocelectomy

Abstract

The gold standard of varicocele management is microsurgical subinguinal varicocelectomy. This procedure leads to better preservation of the testicular artery and lymphatic vessels. However, sometimes several vessels were in complex position causing the dissection to be more difficult. By using IVDU, more arteries and veins could be identified to acquire better sperm outcomes. It's uncertain if the Doppler Ultrasonography has a role in varicocele therapy. The goal of this systematic review and meta-analysis was to see how effective microsurgical subinguinal varicocelectomy with intraoperative vascular Doppler ultrasonography compared to without intraoperative vascular Doppler ultrasonography. Randomized Controlled Trials (RCTs), non-randomized trials, and comparative observational studies were searched and screened in the Embase, Medline, and Scopus databases for research examining the role of intraoperative Doppler ultrasonography. The Cochrane risk of bias (RoB) tool 2 was used to assess RCT bias, whereas the ROBINS-I tool was utilized to assess non-randomized trial bias. The New Ottawa Scale was used to evaluate observational research. The systematic search and screening yielded five suitable studies, including three RCTs, one non-randomized trial, and one observational research. Between patients receiving IVDU and those having the treatment without IVDU, there is a significant difference in the number of ligated veins (MD 0,94; 95 percent CI 0,62?1,26; p0,00001) and preserved arteries (MD 0,43; 95 percent CI 0,30?057; p0,00001). Patients receiving IVDU had better ligated veins and preserved arteries than patients having the surgery without IVDU.