Beyond Tying Knots: Can Venous Bypass Shape the Future of Testicular Hemodynamics in Varicocele Treatment? – A Systematic Review
Bibliographic record
Abstract
Albert Ciam, Ricky Adriansjah Urology Department, Hasan Sadikin Academic Medical Center, Universitas Padjajaran, Bandung, IndonesiaCorrespondence: Ricky Adriansjah, Urology Department, Hasan Sadikin Academic Medical Center, Universitas Padjadjaran, Jl. Prof. Eyckman No. 38, Bandung, West Java, 40161, Indonesia, Tel +62 811-2296-136, Email ricky.adriansjah@unpad.ac.idPurpose: Varicocele, present in 15– 20% of males and linked to 35– 40% of primary infertility, is commonly treated with microsurgical ligation. This review compares venous shunting techniques such as spermatic-inferior epigastric vein anastomosis with ligation in terms of efficacy, safety, and clinical outcomes, especially in complex cases like recurrence or Nutcracker Syndrome.Methods: We included randomized, prospective, retrospective, and cohort studies comparing venous shunting (eg, spermatic-inferior epigastric vein anastomosis) with ligation or without control group. We searched PubMed, EBSCO, ProQuest, EMBASE, and Scopus on 31 April 2025. Risk of bias was assessed using the Newcastle-Ottawa Scale and JBI (Joanna Briggs Institute) for case series. Outcomes assessed included operative time, semen parameters, hormonal levels, recurrence, and complications. This study was registered in PROSPERO (CRD420251060842).Results: Twelve studies (n = 420 patients) were included. Shunting demonstrated improvements in semen quality (eg, sperm motility: 59.4% vs 41.6% post-ligation) and lower recurrence rates (0– 5% vs 5– 15%). However, operative times were longer (99– 146 vs 48– 92 minutes). Shunting also showed benefits in vascular parameters and testicular volume, particularly in NCS-associated cases. Complications were rare, with minor issues like scrotal edema reported.Conclusion: Venous shunting shows promise as an alternative in selected varicocele patients, with potential benefits in semen motility, pain relief, and recurrence reduction. However, the current evidence is limited, heterogeneous, and largely non-randomized. Shunting should therefore be considered experimental, requiring advanced microsurgical expertise, and further high-quality trials are needed before incorporation into standard guidelines.Keywords: varicocele, venous bypass, microsurgical anastomosis, male infertility
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.027 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.006 |
| Bibliometrics | 0.003 | 0.004 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".