Introduction. Varicocele is a common condition in men that affects fertility. There are many options for varicocele surgical treatment. Marmar operation shows the best results.

Purpose of the study. To study the efficiency of microsurgical varicocelectomy among initially operated patients.

Materials and methods. We performed microsurgical treatment in 198 patients with varicocele for 5 years in Pirogov First City Hospital. The mean age of patients was 28 years. 121 patients (61.1%) underwent surgery because of pain syndrome. Infertility was identified in 84 patients (42.4%). Pathospermia was determined in 147 patients (74.2%). Testicular hypotrophy was noted in 68 patients (34,3%).

Results. Scrotal pain was relieved in 108 patients (90%). Within 6-36 months after the operation 25 couples (29.8%) had a natural conception. Improvements in sperm parameters were achieved in 104 patients (70.8%). Testicular volume increased at 2.0±0.5 ml in average. Postoperative hydrocele was observed in 5 patients (2.5%). Once wound suppuration was observed. No cases of testicular atrophy were identified. The recurrence rate was 3.5% (n=7).

Conclusion. Microsurgical varicocelectomy is the optimal varicocele treatment in terms of efficacy, recurrence rate and complications. Using of microsurgical techniques and instruments makes it possible to identify precisely all venous trunks, including small collaterals, and minimize the risk of intraoperative injury of the testicular artery and lymphatic vessels. Marmar operation is the method of choice in initial treatment of patients with primary diagnosed varicocele.