Venography has recently been introduced in routine diagnostic evaluation of varicocele, and a pathogenetic classification based on venographic findings has been proposed. Transcatheter sclerotization of the internal spermatic vein completes the angiographic management of varicocele. After venographic classification of 56 cases, the patients with type-1 varicocele (reno-spermatic reflux) were treated by transcatheter sclerotization (group A, 25 patients) or high inguinal surgical ligation (group B, 15 patients). The results were quite similar, whereas the cost/benefit ratio was favorable to sclerotherapy.