الفهرس 
Anatomical BackgroundOnly 14 pages are availabe for public view
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Abstract
Varicocele is a disorder characterized by dilated, tortuous veins within the pampiniform plexus of veins in the scrotum. It is a relatively common condition, representing in about 35% of males with primary infertility and 75–81% of males with secondary infertility.
It is obviously recognized that the existence of varicocele is linked to an increased risk of change of sperm parameters, though the mechanisms have not yet been completely confirmed, it is considered to be multifactorial. The point that varicocele lead to higher levels of reactive oxygen species (ROS) was confirmed by recent studies which in turn results in sperm DNA fragmentation, leading to inadequate sperm function and fertilization outcome caused by varicocele.
The etiology of varicocele is considered to be multifactorial. The anatomical differences between the left and right internal spermatic veins (causing the predominance of left-sided varicocele), the incompetence of the valves of the veins resulting in reflux of venous blood and the nutcracker phenomenon are the most popular theories.
Clinical varicoceles can be detected by physical examination, whereas subclinical varicoceles can be only diagnosed by imaging, such as Duplex ultrasound.
Differentiation between primary varicoceles and secondary varicoceles that are caused by external compression (intra-abdominal neoplasms or inguinal canal masses) should be considered.
A variety of treatment approaches, including surgical or interventional strategies, have been used for varicocelectomy. The ultimate goal is to stop the veins from refluxing to the testis and preserving arterial and lymphatic drainage.
Many methods were tried for varicocele treatment starting from the traditional open surgery up to the minimally invasive radio-interventional and magnification assisted technologies. Hence, the debate regenerates about which is the best technique for repair of varicocele. Many trials discussed this issue in comparative studies including the different approaches of repair.
Considering this ongoing controversy, we aimed at comparing the outcome of surgical repair (by microsurgical sub-inguinal method) and endovascular embolization (using cyanoacrylate glue) of varicocele as regards improvement of both semen analysis parameters & pre-operative symptoms of both procedures.
This study is a prospective randomized study that has been conducted at Ain Shams University Hospitals, Ahmed Maher Teaching Hospital and other authorized hospitals under supervision of thesis supervisors.
The study included forty primary varicocele patients by the method of simple random sampling of patients with primary varicocele.
The 40 patients of the study were subjected into two groups. group (A) included 20 patients that have been managed by surgical varicocelectomy (microsurgical sub-inguinal technique). group (B) included the rest twenty patients that have been managed by endovascular embolization technique (using cyanoacrylate glue).
The study results denote that both sub-inguinal microsurgery approach & percutaneous embolization provide increase in sperm quality and significant improvement of symptomatic scrotal pain.
However our study showed better results regarding sperm concentration in patients managed by microsurgical sub-inguinal varicocelectomy as comparing 6 months postoperative follow up sperm concentration results between the two groups showed that group (A) range was from 17 to 28 million/ml with a mean of 22.450±2.856 & group (B) sperm concentration range was from 15 to 27 million/ml with a mean of 20.400±3.378 (denoting more successful results regarding sperm concentration in patients managed by microsurgical sub-inguinal method with significant P-value =0.045).