الفهرس 
ANATOMYOnly 14 pages are availabe for public view
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Abstract
Varicocele is an abnormal dilatation of the pampiniform plexus of veins surrounding the testicles, and accompanying the spermatic cord. Varicocele exerts a wide range of impact on seminal parameters ranging from none to absolute azoospermia with testicular atrophy. Indications for management of a varicocele Include: pain,mass, psychic or cosmetic problems, subfertility or infertility, and affection in childhood or adolescents for fear of possible future testicular damage. Seminal improvement may be evident as early as 3 months,although most patients will require up to 1 year or more to plateau. The established methods of interruption of this reflux consist of either open or laparoscopic retro-peritoneal ligation, inguinal ligation or percutaneous embolization Laparoscopic varicocelectomy gives the advantages of the laparoscopic approach including minimal surgical trauma, lower morbidity and time sparing, faster recovery, better microscopic dissection with preservation of the spermatic artery along amenable bilateral ligation without a second incision. The procedure is also associated with the possible complications of trans peritoneal laparoscopy such as injury to the bowel,vessels and ileus Our study designed to evaluate the feasibility and outcomes of laparoscopic varicocelectomy with preservation of the testicular artery in adolescents. Many hypotheses have been proposed to explain the mechanism by which varicocele exert a bilateral deleterious effect on spermatogenesis: (hyperthermia, hypoxia, Renal-adrenal reflux, alteration in the hypothalamo – pituitary gonadal axis, formation of anti-spermatozoal antibodies, mechanical Obstruction of the intra testicular pathways). Clinically, there are three grades of varicocele, grade I is small, only palpable with Valsalva’s Maneuver. Grade II is moderate, nonvisible and palpable with standing. Grade III is large, visible on gross inspection In recent reports, the sensitivity and specificity of varicocele detection approaches 100% with color Doppler US. Failure of conventional methods for the treatment of varicocele is claimed to be due to variations regarding the anatomy of pampiniform plexus, and the haemodynamic variation regarding the cause of varicocele, these together with the complex anastmosis between the spermatic system and various veins along its course (inferior vena cava, renal,intercostal, ureteral, lumbar, perivertebral and epigastric veins)along with vertical anastmosis between different segments of the spermatic vein, had made the preference of a perfect operation for varicocele impossible. An extended varicocelectomy that includes the cremasteric vein is claimed to reduce the incidence of recurrence in pediatric cases. Our study included 20 patients managed by laparoscopic artery saving varicocelectomy with lymphatic sparing. We found significant increase in spermatic count ,also highly significant increase in motility of sperms after surgery, hydrocele formation in 2 cases only, testicular catch up growth in 5 cases ,no testicular atrophy in the other cases and recurrence occurred in 2 cases in the period of follow up (6 months).