INTRODUCTION: The objective was to compare the semen quality and hormonal levels of patients with variocele
receiving antegrade scrotal sclerotherapy (ASS) alone versus a combination of ASS and tamoxifen.
METHODS: The design was a cross-sectional investigation of 72 patients with varicocele that were surgically
managed with ASS. The patients were admitted to the hospital urology department from January to June 2009 with
different grades of varicocele and infertility. They were randomly divided into 2 groups: 37 patients underwent
ASS only; 35 patients underwent ASS and received tamoxifen citrate 10 mg twice daily, starting immediately after
ASS and continuing for 6 months. All patients were evaluated preoperatively and postoperatively by history,
clinical examination, semen analysis, and Doppler ultrasound. Hormonal assay was indicated in cases of severe
oligospermia. Outcome measures were semen parameters and hormonal levels. Operative time, length of hospital
stay, length of time before return to normal activity, recurrence rate, and cost of each procedure were also recorded.
RESULTS: The mean (SD) ASS operative time was 20 (6.4) minutes for patients with unilateral varicocele and 28
(10.8) minutes for patients with bilateral varicocele. The hospital stay for patients with unilateral and bilateral
surgery was < 24 hours and < 30 hours, respectively. Patients in both groups showed statistically significant
improvement in semen count, motility, and abnormal forms 6 months after surgery (P < .001). Over 70% of the
patients in both groups had improvement in all 3 measures and there were no significant group differences (P >
.05). Eleven out of 35 patients in group 2 required hormonal assessment because they had severe oligozoospermia.
There was a significant improvement in hormonal levels following treatment (P < .01). Over 80% of the patients
in both groups had no recurrence. Persistent varicocele occurred in 10 patients (13.9%), scrotal hematoma in 5
patients, and postoperative scrotal pain in 1 patient.
CONCLUSION: ASS for varicocele in male infertility due to varicocele significantly improves semen parameters
with or without tamoxifen. ASS is a rapid, effective, and low-cost procedure. |
