Integrating bibliometrics and real-world data to map varicocele research and predict surgical outcomes

Background: Varicocele represents the most prevalent amendable factor contributing to male infertility. Despite this, considerable debate continues concerning the effectiveness of surgical intervention, especially in terms of enhancing pregnancy outcomes. Simultaneously, the body of literature in this domain is expanding swiftly, necessitating systematic organization. Objective: This study seeks to delineate the research landscape surrounding varicocele, evaluate the effectiveness of surgical treatment, and investigate critical predictive factors affecting surgical outcomes by synthesizing bibliometric analysis with empirical clinical data. Methods: Initially, we extracted pertinent literature spanning from 2004 to 2025 from the Web of Science Core Collection. Utilizing bibliometric analysis tools such as CiteSpace, VOSviewer, and Bibliometrix R, we analyzed 2,186 publications to assess research trends, contributions by country, prominent authors, journal distribution, and emerging research hotspots. Subsequently, we conducted an empirical study involving 113 infertile patients who underwent microsurgical varicocelectomy (MSV). We compared their semen parameters before and after the surgery and employed multiple linear regression and random forest models to evaluate the influence of factors such as age, venous diameter, and reflux duration on surgical outcomes. Results: The bibliometric analysis demonstrated a consistent annual growth in publications within this field. The United States, China, and Italy emerged as the leading contributors. Agarwal A was identified as the most prolific and influential author. Current research frontiers are centered on oxidative stress and sperm DNA fragmentation. A real-world study substantiated that MSV significantly enhanced various semen parameters. Specifically, sperm concentration, total sperm count, the percentage of progressively motile sperm, and the total number of progressively motile sperm increased by 68.1%, 84.2%, 53.7%, and 135.7%, respectively. Predictive modeling revealed that reflux duration, preoperative sperm concentration, and age were the most critical factors affecting the improvement in the total number of progressively motile sperm. Conversely, venous diameter was identified as the primary factor influencing enhancements in the percentage of progressively motile sperm and the sperm abnormality rate. Conclusion: Our findings confirm that microsurgical repair significantly improves semen parameters. We therefore advocate for a refined varicocele classification system that incorporates venous diameter, patient age, and reflux duration to enhance clinical decision-making and patient selection.