The real impact of varicocele on fertility as well as the benefit of its treatment in the management of male infertility are subjects widely debated in the literature. Infertility is defined as the inability to conceive after one year of frequent unprotected sexual intercourse. It is called primary if the couple has never had a child, secondary if the patient already has one or more children, but cannot conceive a new child [3,4].

The origin of varicocele is multifactorial, the diagnosis is clinical coupled with scrotal Doppler ultrasound which proves to be the reference diagnostic tool, because it is a simple, non-invasive, reproducible and inexpensive examination. Several mechanisms have been proposed to explain infertility but none are really proven. Suggested mechanisms include hypoxia and stasis, testicular venous hypertension, increased temperature, and increased catecholamines in the spermatic vein as well as increased oxidative stress [3-5].

Histological lesions of the testicle in a patient with varicocele affect all cell types and compartments: degeneration and desquamation of germ cells in the lumen of the tubule, arrest of spermatogenesis at different stages, thickening of the basal membrane of the tubes seminiferous cells, vacuolation of Sertoli cells, hyperplasia or more rarely atrophy of Leydig cells, degenerative lesions of capillaries and venules (endothelial hypertrophy, luminal narrowing, thickening of the basement membrane) [6].

Testicular hypotrophy is one of the recognized consequences of varicocele in adolescents and adults. Measuring testicular volume to look for hypotrophy is an essential step in the care of an adolescent with a varicocele. The volume of a normal testicle before puberty is 1 to 2 ml. A volume greater than 3 ml indicates the start of puberty. During puberty, testicular volume increases. The frequency of testicular hypotrophy is variously appreciated from 29% to 87% [7].

In our study, the testicular hypotrophy was in 20.68%, and this hypotrophy was more marked on the left than on the right.

The biological assessment of a patient consulting for varicocele with infertility should include the spermogram which remains the first-line examination in the assessment of the infertile man associated with a dosage of pituitary stimuli (FSH/LH) and a dosage of testosterone serum. FSH regulates spermatogenesis and its level usually increases in secretory infertility. LH regulates the blood level of androgens and testosterone has a fundamental trophic and functional effect on the seminal pathway [8,9].

Semen analysis reveals oligozoospermia, generally with low motility of sperm (asthenozoospermia) and a lower than normal proportion of sperm with normal morphology (teratozoospermia) [10,11].

Oligo-astheno-teratozoospermia constituted the most common cytospermiological anomaly found in our series of cases, with 34.48% of cases.

The objective of treatment is to stop testicular suffering or to reverse the growth deficit of the testicle, especially during puberty and thus preserve the patient's fertility. Treatment of varicocele should only be offered if all of the following conditions are present: The varicocele is palpable, the couple's infertility is documented, there is no female infertility problem or it is potentially curable, there is at least one abnormality of sperm parameters in the spermogram. Improvement in the spermogram is seen in nearly 70% of operated patients. It is mainly mobility which is improved (70%) then concentration (51%) and in 44% of patients the morphology of the spermatozoa according to the literature [12,13].

Medical treatments are indicated above all to correct possible hormonal insufficiency. A period of supervision is almost always justified in adolescents. Not only does it belong to a given severity stage of the varicocele which guides the therapeutic decision, but also the evolutionary path. We must never forget that in the post-pubertal phase, a certain number of varicoceles stabilize or even partially regress. Medical treatment can be designed either in isolation or in association with surgical or percutaneous interruption of spermatic reflux [14].

Various therapeutic options are known for the treatment of a varicocele, both open surgical, microsurgical and radio-interventional. Each technique has its own advantages and disadvantages, and conflicting results have been obtained in different studies, but to date there has been no consensus as to which technique should be considered the gold standard for varicocele treatment [15,16].

A study conducted from January 2012 to January 2018 at Split University Hospital, Spinciceva in Croatia which compared open varicocele treatment versus laparoscopy demonstrated that the laparoscopic approach has a significantly lower rate of postoperative complications and recurrences. as well as a shorter operating time compared to the open approach. Faster recovery and shorter hospitalization are also noted after a laparoscopic approach, however no statistically significant difference between supra-inguinal, infra-inguinal or inguinal varicocele treatment regarding the total number and motility of spermatozoa in the spermogram and that all operating techniques led to a statistically significant improvement in the spermogram [16].

In our case series, the laparoscopic approach was the most used technique in almost all of our patients (76.93%).

Several studies have shown that men with grade 3 varicoceles have greater improvements in semen parameters than men with grades 1 and 2 varicoceles after varicocele repair [17].