Evaluation of the efficacy of subinguinal antegrade sclerotherapy and subinguinal micro varicocelectomy versus a combined approach on the semen parameters in infertile patients: a randomized prospective comparative study

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BACKGROUND: We assessed whether a combined approach of subinguinal antegrade sclerotherapy (SAS) and subinguinal micro varicocelectomy (MVS) can provide effective and safe treatment of varicocele regarding semen quality and recurrence rate compared to each approach individually. RESULTS: The median count significantly increased at baseline, and after 3 months, 6 months to be 13.0, 35.0, 40.0, respectively. The median motility significantly increased at baseline, and after 3 months, 6 months to be 37.0, 50.0, and 55.0, respectively. Intra-group comparisons showed significant improvement regarding the median total sperm motility among the participants over the same period. Furthermore, a significant improvement in the median progressive motility among the participants over the same period was observed. Remarkably, the median abnormal forms significantly reduced among the 3 groups at baseline, and after 3 months, 6 months, respectively. Highly significant post-operative reductions in the left and right veins diameters were noted in the intra-group comparisons, with subsequent non visualization of the post-operative left and right veins reflux. Moreover, the median operative time for the left-sided procedures in the 3 groups was 29.5 minutes, 20 minutes, 25 minutes, respectively. For bilateral procedures, the mean operative time was significantly longer in group (A) (57.86 ± 5.2 min) compared to groups B and C (36.93 ± 4.3 min; 44.17 ± 3.45 min, respectively). It should be mentioned that the incidence of orchialgia was significantly absent in the combined approach compared to each approach individually. CONCLUSION: Subinguinal MSV and SAS resulted in a significant post-operative improvement in the semen parameters. Nevertheless, combined approach should be recommended as it is associated with the lowest incidence of complications. Future studies with larger scales are needed to assert the current results.

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