Impact of Intraoperative Doppler Ultrasound on Outcomes of Microsurgical Subinguinal Varicocelectomy: A Systematic Review and Meta-Analysis

Purpose: Purpose: To evaluate the impact of intraoperative Doppler ultrasound (IDU) during microsurgical subinguinal varicocelectomy (MSV) on surgical outcomes, complication rates, and reproductive parameters.Materials and Methods: Materials and Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA and MOOSE guidelines (PROSPERO: CRD420250656066).A comprehensive literature search was performed in PubMed and Scopus up to December 2024.Studies enrolling men with varicocele (Population) who underwent MSV with IDU (Intervention) were compared with those who underwent MSV without IDU (Comparison).Primary outcomes included fertility outcomes (pregnancy rates, sperm parameters), pain resolution, and postoperative complications (recurrence, hydrocele, testicular atrophy).Secondary outcomes included operative time, number of preserved arteries, ligated veins, and preserved lymphatic vessels.Statistical analyses used fixed-or random-effects models depending on heterogeneity.Results: Results: Seven studies involving 1,044 patients were included.While no differences were found in sperm concentration or morphology, progressive sperm motility improved significantly with (mean difference [MD] 12.10%; 95% confidence interval [CI] 3.47 to 20.72; p=0.006).Pregnancy rates were similar between groups.Two studies assessed postoperative pain; both showed improvement, with one reporting higher complete pain resolution using Doppler, but heterogeneity prevented meta-analysis.No significant difference was observed in varicocele recurrence, hydrocele formation, or testicular atrophy.Intraoperative Doppler significantly reduced operative time in unilateral varicocelectomy (MD -5.90 minutes; 95% CI -9.78 to -2.02; p=0.003) but not in bilateral cases.IDU improved arterial preservation (MD 0.44 arteries per patient; 95% CI 0.32 to 0.57; p<0.0001) and led to more veins being ligated (MD 1.06 veins; 95% CI 0.80 to 1.33; p<0.0001).