الفهرس 
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Abstract
The arterial supply to the testis has three major components: the testicular artery (TA), the cremasteric artery and the deferential artery, among which two thirds are supplied by TA. TA divides into two branches in testis, while the capsular artery (CA) continues in the surface of the testis and the intratesticular artery (ITA) in the parenchyma and deep. Previous studies indicate that Color Doppler Flow Imaging (CDFI) is well established to illustrate macro-microvascularity and therefore perfusion of the testis. [72]
Varicocele is defined as the hemodynamic impairment of testicular venous network with continuous blood reflux in pampiniform plexus and characterized by the abnormal dilation and retrograde flow in the affected veins. The estimated incidence of varicocele is about 20% in the general population rising to almost 40% in subfertile men. The effects of varicocele include reduced ipsilateral testicular volume, impaired sperm production ranging from oligozoospermia to complete azoospermia, and reduced fertility. [71]
Three theories have been postulated to explain the origin of varicocele which are not mutually exclusive. The first describes the right angled insertion of the left testicular vein into the left renal vein, the second describes the nutcracker effect of the superior mesenteric artery and abdominal aorta on the left renal vein, the third relies on congenital incompetent (or absent) venous valves inside the testicular vein. [54]
Varicocele may manifest in a variety of ways from being asymptoatic, which is the most common, to infertility. Scrotal pain, mass, disfigurement and reduced testicular volume are the main patient complaint. Physical examination should be carried out in a warm room with the patient in the supine and standing positions, resting and with Valsalva maneuver. [35]
Color Doppler Ultrasonography (CDU) is considered the best non-invasive diagnostic tool. Spermatic venography and thermography are more invasive and rarely used investigation for diagnosis of varicocele. Semen analysis and assisement of testicular volumes are not only important for initial clinical planning but are also helpful in assessing response to treatment. [38]
Varicocele is considered a very benign disease that is always slowly progressive and its complications are on the long term. These complications include progression of the disease, testicular hypotrophy and affection of fertility. Also testicular volume affection is one of the most distressing long term consequence of long standing varicocele especially on boys, adolescents and young men. [71].