Varicocele embolization using n-butyl cyanoacrylate glue: a systematic review and meta-analysis

Purpose Varicocele, a dilation of the pampiniform plexus, is a common and potentially reversible cause of male infertility, contributing to up to 50% of cases. Symptoms may include scrotal pain, heaviness, and cosmetic concerns. Percutaneous embolization is a minimally invasive treatment with high success rates. N-Butyl cyanoacrylate (NBCA)/N-butyl cyanoacrylate-methacryloxysulfolane (NBCA-MS) glue is increasingly utilized due to improved safety. This meta-analysis evaluates the technical and clinical success of NBCA/NBCA-MS embolization in varicocele-related disease. Methods A systematic review and proportional meta-analysis was conducted per PRISMA guidelines (PROSPERO: CRD420261332073). PubMed, Embase, and CENTRAL were searched up to March 4, 2026. Retrospective and prospective studies reporting NBCA/NBCA-MS embolization outcomes were included. Primary outcomes were technical and clinical success; secondary outcomes included recurrence. Proportions were pooled using a random-effects model with Freeman–Tukey transformation, and heterogeneity was assessed using I 2 . Results Eleven studies (five prospective, six retrospective) composed of 548 patients (10 cohorts) were included for analysis. Technical success was 100% across nine studies, with recurrence (eight studies) reported at 1% (95% CI 0–5%; I 2 =72.35%), fertility improvement (three studies) at 68% (95% CI 0.51–0.83; I 2 =70.3%), and pain improvement (three studies) was found to be 97% (95% CI 0.75–1.00; I 2 =79.8%) across reported cohorts.. Conclusion Overall, embolization studies reported high technical success and low recurrence rates, as well as high reported rates of fertility and pain improvement; however, these findings should be interpreted cautiously given the small number of contributing studies and substantial between-study heterogeneity.