title: Effects of micronised purified flavonoid fraction on pain, spermiogram and scrotal color Doppler parameters in patients with painful varicocele.
abstract: OBJECTIVE
  Micronised purified flavonoid fraction (MPFF) is a phlebotropic drug improving venous tone, elasticity and lymphatic drainage, decreasing venous distensibility, venous emptying times, reflux time of venous blood and capillary hyperpermeability, and having antioxidant activities. Since varicocele is a venous pathology, we evaluated the effects of MPFF on pain, spermiogram and color Doppler parameters in patients with painful varicocele.
  
  
  METHODS
  Semen analyses and Doppler sonography were performed in 16 patients (aged 20-62 years, mean 31.2 +/- 10.9) before and after 1,000 mg/day MPFF treatment. Pain change was assessed with visual analogue scale scored between 0 and 10. Patient satisfaction with outcome and side effects were recorded.
  
  
  RESULTS
  Mean pain scores at 1, 3, and 6 months were 1.25 +/- 1.34, 0.25 +/- 0.68, and 0.12 +/- 0.34, respectively, all being significantly lower (p < 0.001 for each) than baseline (4.93 +/- 1.77). Mean score at 12 months (0.93 +/- 1.06) was still lower than baseline (p < 0.001) but higher than at 6 months (p = 0.019). Respectively, 14 (87.5%) and 2 (12.5%) patients reported complete and very significant resolution of pain at the 6th month. All patients were very satisfied with the outcome. While semen volume, total sperm count, sperm concentration and morphology did not change significantly, motility increased significantly (p = 0.009) due to decrease of grade 0 sperms (p = 0.006) and increase of grade 3 + 4 sperms (p < 0.001). Reflux time of left spermatic vein during the Valsalva maneuver decreased significantly (p = 0.003). No significant change occurred in reflux time of the right spermatic vein. No side effect was recorded.
  
  
  CONCLUSIONS
  Results of this preliminary study suggest the safety and efficacy of MPFF in the treatment of varicocele-associated pain. However, no recommendation for the use of MPFF in the treatment of pain associated with varicocele can be made before these preliminary results are confirmed by a randomized placebo-controlled trial.
authors.affiliation: Department of Urology, Inonu University School of Medicine, Turgut Ozal Medical Central, Malatya, Turkey. skilic@inonu.edu.tr
authors.forename: Süleyman
authors.initials: S
authors.lastname: Kiliç
authors.forename: Ali
authors.initials: A
authors.lastname: Güneş
authors.forename: Deniz
authors.initials: D
authors.lastname: Ipek
authors.forename: Abdurrahim
authors.initials: A
authors.lastname: Dusak
authors.forename: Gülsen
authors.initials: G
authors.lastname: Güneş
authors.forename: Mevlana Derya
authors.initials: MD
authors.lastname: Balbay
authors.forename: Yaşar Can
authors.initials: YC
authors.lastname: Baydinç
mesh_terms: D000328:Adult; D005419:Flavonoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D010147:Pain Measurement; D010865:Pilot Projects; D012611:Scrotum / Q000000981:diagnostic imaging*; D018615:Ultrasonography, Doppler, Color; D014646:Varicocele / Q000150:complications / Q000000981:diagnostic imaging*
chemical_list: D005419:Flavonoids