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Abstract
A Varicocele can be defined as an abnormal tortuosity and dilation of the veins of the pampiniform plexus , Which is normally secondry to internal spermatic vein reflux(1-2) . Varicoceles are found in approximately 15 % of the general population including adolescents and adults (3) , in 35 % of men with primary infertility ( reported range : 19 %– 41 % ) (4) and in 80 % of men with secondry infertility. . Clinically, varicocele occur more commonly as isolated left-sided lesions( 60 % _ 90 %) Although the incidence of bilateral varicoceles historically has been reported to be approximately 10 % , more recent studies have shown bilaterality in 30 % _50 % of cases(5_6), the isolated right-sided varicocele is uncommon.
. Varicoceles are thought to increase the intratesticular temperature via loss of venous valvular function this leads to pooling of the warm blood in the testis thus causing altered spermatogenesis , leydig cell dysfunction and subsequent infertility (7) . The effects of varicocele vary but may often result in a generalized impairment of sperm production , characterized by abnormal semen quality ranging from Oligospermia to complete Azoospermia , furthermore , the varicocele influences not only the physiology and the reproductive potential of the sperm but also the fertilizing capacity of the haploid male gamete (8). Varicocele repair was demonstrated to improve semen quality and fertility potential in men with Oligospermia also in men with Azoospermia and severe Oligoathenospermia resulted in induction or enhancement of spermatogenesis in 40 % _ 60 % of patients thus demonstrated the benefit of performing a varicocele repair in Azoospermia ( 9-10-11-12 ) . In fact all other open and randomized studies report average pregnancy rates of around 30 % after 12 months , and between 45% and 70% after 24 months amonge couples with primary infertility ( 13-14-15-16) .
. Careful physical examination is mandatory for the accurate diagnosis of varicocele , the distended veins may appear as a vermiform bluish discoloration beneath the scrotal skin DUBIN and AMELAR described the classical ” bag of worms” appearance on palpation(6). )