Objective: To evaluate the benefits of varicocelectomy in men with nonobstructive azoospermia with a new macroscopic artery sparing technique.Setting: Kasr Elaini HospitalPatientsThis study included 80 patients; 40 non-obstructive azoospermic patients with large varicocele group A, 20 severe oligozoospermic patients (count less than one million) with large varicocele group B. Both these groups underwent varicocelectomy using our technique and were followed up for 12-18 months postoperatively. A third group of 20 non-obstructive azoospermic patients with large varicocele were followed up with no intervention as control group C. Main Outcome measure: Improvement in semen parametersResults:Ten patients of group A showed sperm in the ejaculate after varicocelectomy (25%). The histopathology of the improved groups was; hypospermatogenesis, incomplete arrest, round spermatid arrest. None of the patients improved with sertoli cell only syndrome. While in group B, 8/20 patients (40%) improved after varicocelectomy. In group C, 2 patients showed ejaculated sperm in the follow up period (10%). MGG staining for semen cytology, presence of sperm in testicular sperm extraction and favorable histopathology were highly correlated to improvement after varicocelectomy in the azoospermic group. None of these parameters appeared to be linked to improvement in the control group.Recurrence rate with this technique was 5% and identification of the artery was difficult in 8.3% of cases. Conclusion:We consider these technique an efficient varicocelectomy approach which is easy to learn and perform. Moreover, it leads to comparable results with other sophisticated microsurgical techniques which need maintained training and equipped theatres.We advocate considering varicocelectomy in non-obstructive azoospermic patients especially if the semen cytology by MGG revealed spermatogenic cells, or the patient had a favorable histopathologic pattern or proved to be positive at sperm retrieval procedure.