الفهرس 
Aim of the WorkOnly 14 pages are availabe for public view
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Abstract
A varicocele is determined as abnormal tortuous and dilated veins in the pampiniform venous plexus of the scrotal sac. The prevalence of varicocele is between 15 and 20% of the men, up to 35% of male patients with infertility, and 75–81% of secondary male infertility. It is proven that the presence of varicocele is correlated with a risen risk of abnormal sperm parameters (Medicine 2014).
Among varied surgical techniques, microsurgical varicocelectomy has been known as the golden standard for varicocele treatment recently because of its high rate of success and very low rate of complications. The most common approaches are retroperitoneal abdominal laparoscopic, infrainguinal, and sub-inguinal below the groin or intrascrotal (Leslie et al., 2020).
The aim of the work was to evaluate the effectiveness of microsurgical varicocele ligation in comparison with conventional approach as regard to surgical efficacy, pre-operative morbidity, changes in semen parameters, effect on pregnancy rates in cases of subfertile men and the effect on testicular function in the light of changes occurring in the hormonal profile and spermogram pattern of the patients.
The present study was clinical randomised trial done in Menoufia Urology Department including eighty three patients with varicocele. Thirty Eight patients treated by inguinal varicocele ligation & other Fourty five patients treated by microscopic varicocele ligation in the period from December 2018 to December 2020 were included in the study.
All patients were subjected to the following; Detailed history taking including Personal history, Complaint, Present history, Occupational exposure to gonadotoxins, Smoking history, Sexual history, Past history,Family history, Female partner history . Examination; General examination including Vital signs and examination of: chest, heart, abdomen & L.L. Local urological examination including inspection and examination of scrotum and penis. Laboratory evaluation including semen analysis, Serum level of follicle stimulating hormone (FSH), luteinizing hormone (LH) and testosterone, Complete blood count, Serum creatinine, Liver function test, Bleeding profile, Fasting and postprandial blood sugar. Imaging study including color Doppler ultrasound examination of the scrotum. Intraoperative and early and late postoperative evaluation.
The present study showed that:
There is no statistically significant difference between studied groups regarding age, marital status, smoking, main complain, the laterality of varicocele, clinical grade of varicocele, pre-operative testicular size, the largest vein diameter
The change between the pre-operative and the 3 months post-operative improvement of sperm concentration compared between the two groups was statistically insignificant.
The improvement in sperm progressive motility was statistically significant among the microscopic group compared with the conventional group (p value 0.044).
The change between the pre-operative and the 3 months post-operative percentage of normal sperm forms between the 2 groups was insignificant statistical difference (P value 0.783).
There is a statistical difference between the two groups regarding varicocele recurrence and hydrocele formation.
There was no statistically difference between the two groups regarding decrease in testicular size.