Medical therapy of oligoasthenospermia associated with left varicocele.
OBJECTIVE
To ascertain whether a nonsteroidal anti-inflammatory drug (cinnoxicam) or surgical varicocelectomy are suitable therapies for oligoasthenospermia associated with varicocele.


METHODS
Patients who were oligoasthenospermic and had a varicocele were blindly randomized into three groups and the varicocele graded using echo-colour Doppler ultrasonography. In group 1, seven men had grade V, four grade IV and 30 grade III varicoceles; in group 2 eight had grade V, 10 grade IV and 43 grade III; in group 3 six had grade V, eight grade IV and 40 grade III. Group 1 underwent surgery, group 2 received cinnoxicam (one 30 mg suppository every 4 days for 12 months) and group 3 received a placebo (one glycerine suppository every 4 days for 12 months). Sperm was analysed at intervals to follow the response in the three groups, and any side-effects considered.


RESULTS
Surgery significantly increased sperm values in men with grade III-V varicocele within 4 months, the highest values being obtained at 8 and 12 months. Cinnoxicam significantly improved sperm quality after 2 months in men with grade III varicocele, but the results were best at 4 months and stable at 12 months; stopping therapy caused a decline to the baseline values. Cinnoxicam did not change the sperm quality of men with grade IV or V varicocele. The placebo was inactive, and there were no side-effects of active treatment.


CONCLUSIONS
Cinnoxicam is a safe and reliable therapeutic option for men with oligoasthenospermia associated with a grade III varicocele, but surgery is better for those with grade II, IV and V.
Cavallini
G
G
Società Italiana di Studi Medicina della Riproduzione, Reproductive Medicine Unit, Bologna, Italy. giorgiocavallini@libero.it
Biagiotti
G
G
Ferraretti
A P
AP
Gianaroli
L
L
Vitali
G
G
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D009845:Oligospermia / Q000188:drug therapy* / Q000209:etiology; D010894:Piroxicam / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D013076:Sperm Count; D018615:Ultrasonography, Doppler, Color; D014646:Varicocele / Q000150:complications* / Q000000981:diagnostic imaging
D000894:Anti-Inflammatory Agents, Non-Steroidal; D010894:Piroxicam; C057291:piroxicam cinnamate