Background and Aim: Varicocele represents a major reversible cause of male infertility and the most prevalent and recognized cause. Varicocele results in testicular atrophy, poor sperm production, diminished fertility and scrotal discomfort. The sonographic assessment and Scrotal duplex became the modality of choice of evaluating and grading varicocele. The approach helps in assessing testicular dimensions, retrograde flow, diameters of dilated veins, and arterial flow parameters. We aimed to compare between pre and intraoperative scrotal duplex to detect the accuracy of the intraoperative scrotal duplex in the assessment of varicocele. Patients and Methods: Our study is a prospective Cohort study that carried out on 20 male patients were scheduled for subinguinal varicocelectomy. The study was conducted at Dermatology and andrology department in Azhar-Assiut university hospital (tertiary care hospital) It carried out from March 2020 to March 2021.using Grey-Scale US and Doppler US, we did compare between the intraoperative duplex and Preoperative duplex to detect the accuracy of the intraoperative scrotal duplex in the assessment of the degree of the varicocele and tesiticular volume. Results: We found that there was a significant increase in veins number and testicular volume during intra-operative varicocelectomcomparedng to preoperative duplex. There was no significant differnce in vein diameter pre and intra-operative. There was no significant differnce in venous reflux pre and intra-operative. Conclusion: The Intraoperative scrotal duplex US is good and accurate method in assessment of grading of varicocele.