Antegrade scrotal sclerotherapy versus inguinal microsurgical varicocelectomy in the treatment of varicocele – a prospective, randomized, parallel group study La sclérothérapie ante grade de varicocèle versus varicocelectomie microchirurgicale par voie inguinale dans le traitement de la varicocèle - étude prospective randomisée parallèle

Objective: To evaluate the efficacy, safety and cost-effectiveness of antegrade scrotal sclerotherapy (ASS) compared to inguinal microsurgical varicocelectomy (IMV) for the treatment of varicocele of the testis. Patients and Methods Male patients above 13 years of age with grade 2 to 3 varicocele, who were either symptomatic or presented with an abnormal semen analysis, were included in the study. The patients were randomized in a ratio of 1:1 between ASS or IMV. ASS was performed using sodium tetradecyl sulphate (Fibro-vein ) as sclerosing agent in a 1% and 3% mixture. IMV was performed using an inguinal approach and microsurgery loupes during spermatic cord dissection to identify and preserve the testicular artery and lymphatics. Color doppler ultrasound was used to measure testicular volume and pampiniform vein diameter before treatment and at 6 and 12 month follow-up visits. Semen analysis was obtained at the same time intervals. The efficacy parameters included serum follicle stimulating hormone (FSH), luteinizing hormone (LH), semen analysis, pregnancy rate of partners and estimation of costs involved. Results: Between April 2000 and December 2003, 25 patients were included in the study. ASS was performed on 12 patients (6 bilateral procedures) and IMV on 13 patients (2 bilateral). Obliteration of the clinically detectable varicocele was achieved in 10/12 patients in the ASS and in 11/13 in the IMV group (89% and 87% success rate, respectively). ASS was superior to IMV with regard to costs, average theatre time, hospitalization and postoperative recovery. Both procedures had a one year pregnancy rate of 50%. The mean sperm count and mean sperm morphology improved significantly from baseline to 12 months in both groups. However, there were no statistically significant differences between the two methods with regard to semen analysis improvement, testicular volume or biochemical data (LH, FSH, testosterone). Serum FSH decreased in those who had successful treatment of their varicocele, but not in those with recurrence, although the difference was not statistically significant (p=0.09), probably due to the small patient numbers. Conclusion: ASS is a minimally invasive treatment for varicocele, which is feasible as an out-patient procedure in adolescents and adults. It can save costs, theatre time, hospitalization and time lost from work. ASS and IMV appear to be equally successful in terms of varicocele recurrence, pregnancy rate and semen analysis improvement. Résumé Objectifs: Evaluer l'efficacité, la sécurité et la rentabilité de la sclérothérapie ante grade de varicocèle (ASS) comparée à la varicocelectomie microchirurgicale par voie inguinale (IMV) dans le traitement de la varicocèle. Patients et méthodes: Des patients de sexe masculin d'age de plus de 13 ans avec une varicocèle de grade 2 à 3 qui étaient ou symptomatiques ou présentant une anomalie à l'analyse du sperme ont été inclus dans l'étude. Les patients ont été randomisés dans un