NNT and NNH: What Your Surgeon Doesn’t Want You to Know!

NNT of Varicocelectomy & Embolization

The Benefits in Number Needed to Treat (NNT) stands for how many people need to be treated before one benefit is attained. For example, the NNT for surgery is 7, meaning that for every 7 men who undergo the procedure, 1 additional pregnancy will be attained. The NNT for pain relief is not established, nor is the NNT for improving testosterone is not established.

Note that just because your sperm count increases by for example 70%, that doesn't necessarily translate to a successful pregnancy.
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But, notice what the NNT this does not say: It does not say that the swelling will be gone. It does not say that you will not develop chronic pain after the procedure. It does not say anything about the harms of the procedure.
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NNH of Varicocelectomy & Embolization

​So, we also need to educate ourselves about the Number Needed to Harm (NNH). The NNH stands for how many people need to be treated before one harm occurs. For example, for about every 3 men with right-sided varicocele who undergo embolization, 1 redevelops varicocele. Another example, for every 100 men who undergo microsurgery, 1 testicular loss occurs due to arterial damage.

Notice that there still isn’t a real discussion about the most important thing: Alternatives! What other, non-invasive alternatives do you have? How effective are those alternatives in contrasted to surgery and embolization? What are the NNTs? What are the NNHs? Are there more effective alternatives? Especially, if you’re looking for improving your fertility, are there alternative that are both safer and more effective? For pain relief, and restoring normal testosterone too; what are the alternatives? 
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Why You Must Demand More Answers!

​So, you see, knowing about the NNT, helps you ask very specific questions. Don’t just believe “high rate of success”. Ask questions! “High rate of success, for what specific benefit?” “What is the NNT to attain that benefit?” “How strong is the evidence supporting each specific benefit?” “What are the associated harms, and my likelihood of suffering from one of them?” “Are there any alternative treatment methods, especially non-invasive, or lifestyle related that I need to know about?”
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Your Right to Informed Consent:

​Truly, learning about and asking about the NNT and NNH is about practicing your right to informed consent. But, the real problem is that most doctors are so rushed for time that they will almost never give you the complete picture. But, it’s time that we demand not more from our medical practitioners. It’s time that we do our own research when it comes to potentially harmful procedures. It is time that we begin to practice our right to informed consent.
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"NNT Not Established"

"NNT not established" means that there is a lack of scientific backing for the treatment effectiveness. This is the case for varicocelectomy and embolization because researchers are not gathering enough testosterone and pain data. They are not concerened with pain relief or testosterone levels in their experiments. It is indeed a strange thing.

Varicocele Treatment Outcome: NNTs

Varicocelectomy (Surgery)

• Swelling Reduction: 80%-95%
• Improvement of Fertility (Pregnancy): 1 out of 7 (14%)
• Improvement of Testosterone: NNT not established.
• Improvement of Pain Symptoms: NNT not established.

Embolization

• Swelling Reduction: 70%-90%
• Improvement of Fertility (Pregnancy): 1 out of 17 (6%)
• Improvement of Testosterone: NNT not established.
• Improvement of Pain Symptoms: NNT not established.

Varicocele: NNHs for Varicocelectomy:

Pre-Operative Risks:

• Local Anesthetic
  

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Pre-Operative Risks:

• ​General Anesthetic
  • Hypotension
  • Hypoxia
  • Arrhythmia

Intra-Operative Risks:

• Loss of Ipsilateral Testicle (1 in 100)
• ​Bleeding (NNH not established.)
• Failure at attempt (1 in 20)
• Preperitoneal insufflation (NNH not established.)
• Injury to pubic nerves (1 in 20)

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Post-Operative Risks:

• Hematoma
• Shrinking of the testicle on the side of the surgery (1 in 100)
• Hydrocele (1 in 15)
• Persistent/recurrent varicocele (1 in 15)
• Genitofemoral Nerve Injury
• Scrotal Emphysema
• Umbilical Granulomas
• Infection at site of surgery (1 in 100)
• Deep venous thrombosis (DVT) (1 in 20)
• Pulmonary embolus (PE) (1 in 100)
• Onset of pain where there was none before (1 in 100)
• Failure to relieve pain (1 in 6)
• Continued infertility (1 in 1.16)
• Fertility impairment (NNH not established)
• Scarring at incision site (NNH not established)
• Impaired testosterone (NNH not established)

​​Varicocele: NNHs Table for Embolization:

Pre-Operative Risks:

• Local Anesthetic 
• Minimal risks​

Pre-Operative Risks:

• ​General Anesthetic

Intra-Operative Risks

• Adverse reaction to x-ray contrast dye (1 in 66)
• X-ray radiation exposure (1 in 1)
• Bleeding from vein perforation (rupture) (1 in 100)
• Thrombosis of pampiniform plexus (NNH not established.)
• Failure at attempt (1 in 5)

​Post-Operative Risks

• Coil migration resulting in testicular loss (1 in 100)
• Hematoma (1 in 50)
• Hydrocele (1 in 6)
• Persistent/recurrent varicocele (1 in 5)
• Pain pills (1 in 1)
• Failure to relieve pain
• Onset of pain where there was none before (NNH not established.)
• Decreased fertility (NNH not established.)
• ​​Lowered testosterone levels (NNH not established.)

Treat Varicocele at Home, Without Surgery

Our treatment program is very simple:

1. Identify and treat the root-cause of your varicocele, infertility, and pain symptoms
2. Follow symptom-specific treatments (infertility, pain, low testosterone, etc.)
3. Improve testicular and vein health

If you treat the root-cause, alleviate the symptoms, and improve testicular and vein health, then you will no longer have nay disease. It's as simple as that! Learn more.

Varicocele Home Treatment >