This chapter reviews the current concepts and ongoing controversies regarding the pathophysiology, diagnosis, significance, and treatment of the varicocele. Varicocele may also affect reactive oxygen species generation, rendering the testicle and the sperm unable to handle oxidative stress, and resulting in reactive oxygen species buildup. Toxic agents and heavy metals accumulate in tissues undergoing apoptosis, several investigators has examined testicular tissue heavy-metal content in men with varicocele. A pencil-probe Doppler stethoscope has been advocated as an adjunctive tool in the examination of the varicocele. Ultrasonography has become an increasingly useful modality in the diagnosis of varicocele. Surgical varicocelectomy is the cornerstone of varicocele therapy. Several surgical approaches are available to accomplish varicocelectomy. The approaches include the scrotal approach, the subinguinal approach, the inguinal approach, the retroperitoneal approach, and the laparoscopic approach. Azoospermia has generally been regarded as a contraindication to varicocelectomy.