Single Infrapubic Versus Bilateral Subinguinal Microsurgical Varicocelectomy

Inclusion Criteria: * Male patients aged 18 to 45 years. * Clinically palpable bilateral varicocele, grade II or grade III. * Diagnosis confirmed by color Doppler ultrasound. * Infertility for at least 12 months and/or abnormal semen analysis. * Female partner evaluation performed or planned to exclude major uncorrected female-factor infertility. * Patient fit for surgery and anesthesia. * Written informed consent provided by the participant. Exclusion Criteria: * Subclinical varicocele detected only by Doppler ultrasound. * Unilateral varicocele. * Recurrent varicocele after previous surgery, embolization, or sclerotherapy. * Previous inguinal, scrotal, pelvic, or penile surgery likely to distort surgical anatomy. * Associated inguinal hernia, hydrocele, spermatocele, epididymal cyst, or other scrotal condition requiring simultaneous surgery. * Azoospermia, especially suspected non-obstructive azoospermia. * Active urinary tract or genital infection. * Coagulopathy or anticoagulant therapy that cannot be safely interrupted. * Severe obesity, defined as body mass index greater than 40 kg/m², or any anatomical condition preventing safe exposure by either surgical approach. * Refusal to participate or inability to complete follow-up.