NLR as a Predictive Factor for Prognosis after Varicocelectomy Surgery: A Systematic Review

Varicocele, characterized by abnormal dilation of the testicular veins, is a common condition affecting male fertility. The role of the neutrophil-to-lymphocyte ratio (NLR) as a predictive prognostic marker for varicocelectomy outcomes in improving male fertility remains uncertain. This systematic review aims to explore the association between pre-operative NLR levels and varicocele surgery outcomes.

A systematic literature search was performed following PRISMA guidelines, utilizing electronic databases such as PubMed, EMBASE, and Cochrane. Studies published between 2018 and 2024 were included if they examined varicocelectomy surgical outcomes and NLR levels as predictive factors. Data extraction and quality assessment were carried out independently.

Four studies met the inclusion criteria, collectively involving 442 patients. Elevated NLR levels were associated with varicocele surgery failure, indicating the potential impact of inflammation on treatment efficacy. Pre-operative assessment of NLR levels showed promise in identifying candidates likely to benefit from varicocelectomy, thereby optimizing treatment outcomes. This is the first systematic review evaluating the prognostic utility of NLR in varicocelectomy outcomes. Elevated pre-operative NLR levels were associated with poorer surgical outcomes, highlighting their potential for pre-surgical patient stratification.

The findings suggest that incorporating NLR into the pre-operative assessment of infertile men with varicocele could enhance treatment decision-making and improve overall fertility prospects. Elevated NLR levels were associated with varicocele surgery failure, suggesting the detrimental impact of inflammation on treatment efficacy.

Pre-operative assessment of NLR levels may aid in identifying candidates likely to benefit from varicocelectomy, optimizing treatment outcomes.