To prospectively compare and objectively assess the surgical outcome of the three-steps procedure (inguinal extracrural
ligation of varicocele, evertion of the tunica and plication of the cremasteric muscle) and the suprainguinal varicocelectomy in subfertile men, forty six patients having primary varicocele were randomly classified into two groups. Group I (26 patients) underwent the three-steps procedure and Group II (20 patients) underwent the standard suprainguinal varicocelectomy. The semen quality improved in 73% of patients of group I and in 70% of group II. The conception rate was 38% in group I and 35% of group II. The surgical morbidity encountered was negligible in group I while in group II, seroma reported in 10%, hematoma in 5%, hydrocele in 25%, recurrence of varicocele in 30% and testicular artery ligation in 10%, but no testicular atrophy was recorded in either group. These results showed superiority of the three-steps procedure over the suprainguinal varicocelectomy with respect to hospital stay, analgesic requirements, return to work, cost and minimal morbidity. Further tangible benefit to the three steps procedure procedure rests on its simplicity and low risk.