الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
This study aimed to : This study involved 78 patients with clinical left side varicocele ageing from 19-46 years. Forty patients were complaining of primary infertility after at least one year marriage with normal sexual life, while 38 patients were complaining of chronic scrotal pain. These patients were submitted to: Complete medical history; Physical examination; Complete semen analysis; Scrotal duplex sonography. These 78 patients were divided into three groups, the 1st one has undergone open high ligation (35 patients ; 23 infertile and 12 presented with chronic scrotal pain), the 2nd one has undergone subinguinal ligation (35 patients;13 infertile and 22 presented with chronic scrotal pain) and the 3rd one has subjected to laparoscopic transperitoneal ligation of testicular veins (8 patients; 4 for each complaint). There was statistically significant improvement in sperm count , motility and percentage of abnormal forms in open high and subinguinal procedures , while in the laparoscopic group there was significant improvement only in the percentage of abnormal forms . Testicular volume did not change significantly after any of the three approaches. There was statistically significant impact on serum testosterone level after each of the three approaches, while there was no significant change in serum levels of other hormones (FSH, LH and Prolactin). Variables as semen parameters , testicular volumes and serum hormone levels didn’t change significantly between 3- and 6- months postoperatively . Furthermore, there was no significant difference between the different operations as regard their impact on the tested variables . The open high ligation resulted in the least incidence of scrotal pain resolution within 6 months postoperatively. There was an insignificant difference between the three techniques as regard the incidence of pregnancy within one year postoperatively. Laparoscopic ligation resulted in the least requirement of postoperative analgesics and convalescence but comparatively required the longest operative time.
A statistically significant higher rate of postoperative complications (hydrocele and recurrence) occurred after open high ligation. Conclusion: An improvement of the mean sperm count, motility and abnormal forms occurs after varicocelectomy irregardless of the type of operation. Scrotal duplex sonography is an easy, safe and reliable method for diagnosis, grading of varicocele and detection of recurrence postoperatively. A postoperative three month duration is sufficient for recovery of semen parameters and serum testosterone concentration. Both subinguinal and laparoscopic approaches have less post operative recurrence and hydrocele as compared with open high ligation. Therefore they are more preferable.