This current study included forty cases with primary varicocele. They ranged in age from 17 to 36 years (mean = 25.95 years), which correspond to age of incidence primary varicocele (young adult). The mean duration of the disease was 18.6 months. All the patients were subjected to laparoscopic varicocelectomy.
It was found in this study that pain represented the most common presentation (50%), followed by infertility (25%) and swelling represented (25%). Kolon et al 2015, reported that pain represent the commonest presentation of varicocele .
It was noticed that the mean age of the patients with pain (26 years), those with infertility (27.4 years) and those with swelling (24.4 years).
Physical examination in a warm room is the mainstay of diagnosis of varicocele, but this is affected by a low sensibility and specificity, especially in cases of low-grade varicocele. Color Doppler ultrasound is a reliable and non-invasive diagnostic method for the evaluation of varicocele which allows the detection of even subclinical varicocele due to its capacity for measuring the size of the pampiniform plexus and blood flow parameters of the spermatic veins.
Color flow Doppler ultrasound optimized for low-flow velocities which confirms the venous flow pattern, with phasic variation and retrograde filling during a Valsalva maneuver. The sensitivity and specificity of varicocele detection approaches 100% with color Doppler ultrasound. In this study, color Doppler study revealed additional fourteen cases with bilateral disease that were not detected clinically.
Primary varicocele, by far is more common on the left side in approximately 90% of cases, it is bilateral in 8 to 9% and is right sided in 1 to 2%. The etiology is related to the unique anatomy of the left testicular vein, which is longer than the right and enters the left renal vein perpendicularly instead of the vena cava (in the right side) with acute angle.
In this study, all the patients had left varicocele, 20% of cases were clinically bilateral and no cases had isolated right varicocele. However, radiological measurements revealed additional seven cases (55%); most of them were grade I.
Comparing the preoperative to postoperative status, it was found that only four case that showed residual affection i.e. 10% recurrence rate.
Several studies have reported an improvement in sperm parameters and pregnancy rates after surgical treatment of varicocele [13–15]
Comparing the preoperative & postoperative semen parameters, The mean spermatic count was 29.08 ± 17.22 × 106/ml, that increased significantly to 35.35 ± 16.138 × 106/ml postoperatively (3M ) and to 39.3 ± 14.85 × 106/ml ( 6M) The overall improvement was about (38.3%).
Al-Kandari and his colleagues (2007)
reported improvement in spermatic count in 67% of cases with laparoscopic varicocelectomy .
In this study spermatic count improved in 38.3% of cases. Lower improvement percentage in this study can be explained by the fact that only 10 cases of 40 presented with infertility and low sperm count.
Will MA et al. (2011) reported improvement in spermatic motility after one hour from 28.42% ± 23.22–39.92% ± 22.06% in their patient’s post-varicocelectomy .
In current study, it was observed that the spermatic motility improved postoperatively after 1st, 2nd, and 3rd hours; although, the improvement was statistically insignificant. The mean spermatic motility after one hour was 45 ± 9.73%, the mean spermatic motility after two hours was 33.75 ± 8.717%, and the mean spermatic motility after three hours was 16%. The spermatic motility improved postoperatively, but not statistically significant.
Regarding abnormal forms, it was observed that there was improvement 34.9 ± 18.04% (preoperative) to 31.75 ± 15.66% (3M post-operative) and to 29 ± 11.65 (6M post-operative). The overall improvement was about (16.9%).
In this work, all the procedures were completed satisfactorily, with no intra-operative complications. The mean operative time, it was 26.15 + 5.03 minute.
Borruto F and his colleagues (2010) reported that operating time was 15 minutes for the laparoscopic varicocelectomy. The more time taken in the laparoscopic group could be explained by that 20% of those patients had bilateral varicocele and were subjected to bilateral intervention .
Most of patients had moderate postoperative pain. 26 of 40 patients received NSAIDs as a post-operative analgesic which was satisfactory to relieve post-operative pain. The remaining 14 patients received paracetamol as analgesics. Two patients experienced a scrotal edema that had improved after 10 days of conservative measures. The hospital stay was (1.15 ± 0.36 day). Barry J and his colleagues (2012) reported that the hospital stay was 1.3 day .
The most frequent complication of varicocelectomy is hydrocele formation, occurring in as many as 30% of the patients. The etiology is likely that of lymphatic obstruction, evidenced by the high average protein content of post varicocelectomy hydroceles compared to that of edematous fluid produced by venous obstruction. 
However, none of the patients in current study developed a postoperative hydrocele. This can be explained by that the testicular artery and lymphatics could be easily identified in most of the cases during this study.
In most cases, identification of the testicular artery could be done successfully. In a study made by Nyirady P (2002) aiming to determine if laparoscopic varicocelectomy with preservation of the testicular artery is a satisfactory alternative to standard open surgical techniques in adolescents. He reported complete correction of the varicocele in 83% of patients. He concluded that the laparoscopic technique with preservation of the testicular artery is an acceptable alternative to open surgical treatment of varicoceles .
Although could improve semen parameters in almost all patients, the sample size of the present study was not large enough to demonstrate that possible improvement. Another limitation of the present study was the absence of a control group of observation or no treatment to add to the debate on the real value of varicocelectomy in treating male infertility.
On follow up the patients included in the study in the clinics, it was observed that patients with laparoscopic varicocelectomy were satisfied with their treatment. Laparoscopic approach carries lesser postoperative morbidity; less post-operative pain with early return to work and in case of bilateral varicocele opposite side is dealt through the same ports. Therefore, if facilities are available for this procedure and once perfection occurs in this minimally invasive technique, this is the procedure that gives lot of satisfaction to the patients as well as the operating surgeon.