{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T05:46:53Z","timestamp":1791870413751,"version":"4.3.4"},"reference-count":82,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Therapeutic Advances in Urology"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:sec><jats:title>Background:<\/jats:title><jats:p> The ideal surgical approach for the management of varicocele in children and adolescents remains controversial. Several techniques are available including artery- or lymphatic-sparing with optical magnification ( via open inguinal or sub-inguinal approach), laparoscopic, antegrade and retrograde embolization\/sclerotherapy. <\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives:<\/jats:title><jats:p> We aimed to appraise the clinical outcomes of these techniques in children and adolescents. <\/jats:p><\/jats:sec><jats:sec><jats:title>Data Sources and Methods:<\/jats:title><jats:p> A systematic review was conducted (1997\u20132023). Meta-analysis or proportional meta-analysis for non-comparative studies (Freeman-Tukey transformation) using the random effects model was conducted. Results are expressed as overall proportion % and 95% con\ufb01dence interval (CI). <\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p> We identified 1910 studies; 632 duplicates were removed, 1278 were screened, 203 were reviewed and 56 were included, with 12 reporting on 2 different techniques (total of 68 data sets). Optical magnification via inguinal approach (498 cases): recurrence 2.5% (0.6\u20135.6), hydrocele 1.6% (0.47\u20133.4), testicular atrophy 1% (0.3\u20132.0), complications 1.1% (0.2\u20132.6); optical magnification via sub-inguinal approach (592 cases): recurrence 2.1% (0.7\u20134.4), hydrocele 1.26% (0.5\u20132.3), testicular atrophy 0.5% (0.1\u20131.3), complications 4% (1.0\u20138.8). Laparoscopic with mass-ligation\/division (1943 cases): recurrence 2.9% (1.5\u20134.6), hydrocele 11.4% (8.3\u201314.9); complications 1.5% (0.6\u20132.9); laparoscopic with lymphatic-sparing (974 cases): recurrence 2.4% (1.5\u20133.5), hydrocele 1.2% (0.45\u20133.36), complications 1.2% (0.05\u20133.9); laparoscopic with artery-sparing (228 cases): recurrence 6.6% (2.3\u201312.9), hydrocele 6.5% (2.6\u201312.0). Antegrade embolization\/sclerotherapy (403 cases): recurrence 7.6% (5.2\u201310.4), hydrocele 0.8% (0.17\u20131.9), technical failure 0.6% (0.1\u20131.6), complications 4.0% (2.3\u20136.1); retrograde embolization\/sclerotherapy (509 cases): recurrence 6.9% (4.6\u20139.5), hydrocele 0.8% (0.05\u20132.5), technical failure 10.2% (4.6\u201317.6), and complications 4.8% (1.0\u201311.2). <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion:<\/jats:title><jats:p> The recurrence rate varies between 2.1% and 7.6% and is higher with the embolization\/sclerotherapy techniques. Post-operative hydrocele rate varies between 0.8% and 11.4% and is higher with the laparoscopic mass-ligation\/division technique. Testicular atrophy has not been reported with the laparoscopic and embolization\/sclerotherapy techniques. The retrograde embolization technique is associated with 10% technical failure (inability to complete the procedure). The laparoscopic lymphatic-sparing technique is characterized by the lowest recurrence rate, incidence of hydrocele and other complications, and no reports of testicular atrophy. <\/jats:p><\/jats:sec>","DOI":"10.1177\/17562872231206239","type":"journal-article","created":{"date-parts":[[2023,10,20]],"date-time":"2023-10-20T13:00:54Z","timestamp":1697806854000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":15,"title":["Outcome following the surgical management of varicocele in children and adolescents: a systematic review and meta-analysis"],"prefix":"10.1177","volume":"15","author":[{"given":"Sarthak","family":"Tandon","sequence":"first","affiliation":[{"name":"Department of Paediatric Surgery, Monash Children\u2019s Hospital, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Bennett","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, Monash Children\u2019s Hospital, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4438-0263","authenticated-orcid":false,"given":"Ramesh","family":"Mark Nataraja","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, Monash Children\u2019s Hospital, Melbourne, Australia"},{"name":"Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia"},{"name":"Department of Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1259-4304","authenticated-orcid":false,"given":"Maurizio","family":"Pacilli","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, Level 5, Monash Children\u2019s Hospital, 246 Clayton Road, Clayton, VIC 3168, Australia"},{"name":"Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia"},{"name":"Department of Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,10,20]]},"reference":[{"key":"bibr1-17562872231206239","doi-asserted-by":"publisher","DOI":"10.1016\/j.sempedsurg.2021.151084"},{"key":"bibr2-17562872231206239","doi-asserted-by":"publisher","DOI":"10.1016\/j.euf.2022.08.014"},{"key":"bibr3-17562872231206239","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(17)32710-6"},{"key":"bibr4-17562872231206239","doi-asserted-by":"publisher","DOI":"10.1177\/1756287218783900"},{"key":"bibr5-17562872231206239","doi-asserted-by":"publisher","DOI":"10.1590\/s1677-5538.ibju.2017.0386"},{"key":"bibr6-17562872231206239","first-page":"575","volume":"25","author":"Ivanissevich O","year":"1918","journal-title":"Sem Med"},{"key":"bibr7-17562872231206239","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(17)69113-4"},{"key":"bibr8-17562872231206239","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-642-83800-2_157"},{"key":"bibr9-17562872231206239","doi-asserted-by":"publisher","DOI":"10.1111\/j.1439-0272.1978.tb01324.x"},{"key":"bibr10-17562872231206239","first-page":"107","volume":"17","author":"Iaccarino V.","year":"1977","journal-title":"Riv Radiol"},{"key":"bibr11-17562872231206239","doi-asserted-by":"publisher","DOI":"10.1186\/2046-4053-4-1"},{"key":"bibr12-17562872231206239","unstructured":"Higgins JPT, Green S (eds). 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