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Abstract Sumnuuy and Conclusion 122 SUMMAR)’ AND CONCLUSION Varicocele IS undoubtedly incriminates as a cause of subfertility. The effect of testicular varicocele; and hence the effective results of its ablation, varies according to the original seminogram. Whether the original picture of the seminogram is the results of only the varicocele or in combination with other, yet, unknown factors is not clear, or it could be due to the duration which the physician is never sure of What is more puzzling is that some men have varicocele and yet have normal seminogram, and effect normal pregnancy. It has been proved that the presence of varicocele on one side affects the function on the other side and this is possibly due to the presence of collateral veins which can not be seen or detected by the traditional operations. A significant relationship between the preoperative testicular volume and sperm density in varicocele patients has been found in this series. The higher the decrease in preoperative sperm density, the higher the loss of testicular volume. --------- Sumnuuy and Conclusion 123 Laparoscopic varicocelectomy undoubtedly having the advantage of detecting the collaterals and clipping them. This certainly explains the overall better results of laparoscopic varicocelectomy. No significant relationship between the grade of varicocele and the preoperative or postoperative seminal parameters has been found, for patients with sperm count > 10X 106/ml.,not only in both groups collectively but also in every group separately. Bilateral varicocelectomy give superior results than unilateral varicocelectomy even if there is no apparent collaterals, and the contralateral side is not clinically evident and hardly detected by Doppler examination which is, often all, a subjective test. Varicocelectomy in patients with sperm density less than ten millions in some cases gives statistically better results but still less than ten millions. Those patients should always have preoperative serum measurements of FSH and testosterone. If it is primary testicular failure, varicocelectomy is not indicated. The best results of varicocelectomy is obtained when the preoperative sperm density is more than ten millions. Laparoscopic varicocelectomy should be considered superior to the classical approach because collateral veins are seen visually -- ---._-._------~-- Sumnuuy and Conclusion 124 and clipped. The laparoscopic approach also allows for accurate identification of the anatomy; artery, vas, vein and collaterals, thus minimizing the risk of injury of these Structures. Bilateral laparoscopic varicocelectomy can be done through the same ports. Morbidity of the laparoscopic procedure is less and the resumption to normal activity is quicker than with the traditional approach. In conclusion : laparoscopic Varicocelectomy adds a new surgical approach with several advantages over the classical operations. |