What is varicocele? Varicocele actually refers to the varicose veins in the spermatic cord, which are the abnormal elongation, dilation and tortuosity of the trapezius plexus (plexus of veins and blood vessels) of the spermatic cord caused by the reflux and stagnation of blood in the veins. In severe cases, they may accumulate in the scrotum in the form of a mass, causing scrotal swelling and discomfort. How are varicose veins caused? The main reason is that the veins in the spermatic cord are long, so if the valves are poorly developed, damaged or incomplete and the smooth muscle or elastic fibers in the walls of the veins are weak, the internal pressure increases and the blood flow is blocked, making varicose veins easy to occur. How should varicocele be treated if I have it? Varicocele can cause continuous and irreversible damage to the testicles, and there are traffic branches on both sides of the testicles, so varicocele on the left side will not only affect the left testicle, but also the right testicle. The latest opinion is that in order to prevent irreversible damage to the testicles, varicocele should be operated on as soon as it is detected. For those who have symptoms such as scrotal swelling and hidden pain, those who have varicocele and abnormal semen or infertility, and those who have varicocele combined with prostatitis and vesiculitis, surgery should be performed in time. In general, varicocele will affect the spermatogenic function of the spermatogenic epithelium of the testicular varicocele and cause infertility. The effect on the interstitium of the testis is less, but there is also the possibility of affecting androgen production and sexual function. Therefore, patients with clearly diagnosed varicocele should be treated surgically in time. In the past, it was thought that some patients with mild varicoceles might resolve on their own after sexual maturity, so mild varicoceles, which are asymptomatic and do not affect fertility, could be left untreated. As the research on subclinical varicocele has intensified, it is believed that subclinical varicocele can also affect testicular function, therefore, patients with various types of varicocele should be treated actively. Some even advocate that adolescents should undergo surgery as early as possible once varicocele is detected to avoid affecting their future fertility. Why does varicocele cause infertility? Varicocele may cause infertility due to the following factors: 1. Blood stagnation in the spermatic vein increases the local temperature of the testis and degenerates the spermatogenic tubules, which affects the occurrence of sperm; 2. Blood stagnation affects the blood circulation of the testis and CO2 accumulation in the testicular tissue affects the occurrence of sperm; 3. Blood from the renal vein that returns from the left internal spermatic vein transfers the metabolites secreted by the adrenal glands and kidneys, such as steroids, catecholamines, 5 Steroids can inhibit spermatogenesis, catecholamines can cause chronic testicular toxicity, and 5-hydroxytryptamine can cause vasoconstriction, resulting in premature sperm shedding; 4, varicocele on the left side can affect the function of the right testis, because there are abundant traffic branches of the veins between the testes bilaterally, and the toxins of the left spermatic vein blood can affect the spermatogenesis of the right testis. Usually, semen examination should be routinely performed for patients with varicocele in clinical practice. The results show that most patients have decreased sperm count, decreased sperm motility, increased number of immature and acromegalic sperm, and in severe cases, no sperm. So what is the best surgical procedure for varicocele? Can it recur? Currently the best surgical procedure is “microscopic spermatic vein high ligation”, microscopic spermatic vein high ligation is easy to identify after finding the spermatic cord and magnifying it several times with a microscope: testicular artery, internal spermatic vein and lymphatic vessels, the artery should be preserved, all internal spermatic veins should be ligated and all lymphatic vessels should be preserved. Ligation of all veins ensures no recurrence of varicocele after surgery, preservation of testicular arteries ensures adequate arterial blood supply to the testes, and preservation of all lymphatic vessels ensures smooth lymphatic reflux to avoid scrotal edema and sphingomyelia after surgery. It is currently the best surgical option for the treatment of varicocele. And about recurrence, the internal spermatic vein is a venous plexus in the scrotum, which converges into 1-2 branches in the inguinal canal and continues upward in the retroperitoneum, and the left internal vein of the spermatic cord enters the left renal vein at right angles. Therefore, theoretically, the possibility of complete ligation of all the internal veins of the spermatic cord is the greatest in retroperitoneal surgery. However, in practice, it is found that in most cases more than two spermatic veins are found during retroperitoneal surgery, and there may be some tiny veins that cannot be identified by the naked eye, or they may not be detected during surgery because they are surrounded by lymphatic vessels, or they are close to the arteries and not easily detected. Therefore, there is a possibility of missing a vein during the surgery, and if there is a missed vein, there is a possibility of recurrence. Generally speaking, the key to recurrence after surgery is whether all the internal spermatic veins are ligated during surgery. If there are residual internal spermatic veins, there is a possibility of recurrence after surgery. Therefore, microscopic spermatic vein high ligation has obvious advantages. With 10 times magnification under the microscope, it is easy to distinguish arteries, veins and lymphatic vessels, and the recurrence rate after surgery is low. The ultrasound is usually repeated after 6 months postoperatively to determine whether there is recurrence. Can varicose vein patients have fertility after spermatic vein ligation? Spermatic vein ligation only removes the factors that cause damage to the testicles, and after the surgery, the blood flow to the testicles will be normalized, and then the fertility will slowly improve. It takes about 72 days for sperm to develop to maturity, so if it is effective after surgery, it usually takes 3 months after surgery to show up in semen analysis. There are many causes of infertility, varicocele being only one of the major factors. The mechanism by which varicocele causes infertility is not well understood, but nearly 40% of infertile men have varicocele, and in more than half of these patients, semen test results improve after surgery. I heard that “ligation” is done for contraceptive purposes, but after “ligation” it is not possible to have children, so why do infertile patients need “ligation” surgery? The “ligation” we mentioned here refers to “ligation of the internal spermatic vein”, which is the ligation of the internal spermatic vein, not the vas deferens. The actual fact that the vas deferens is already separated from the spermatic cord at the internal ring and turned to the prostate, will not damage the vas deferens. The term “ligation” that many people used to hear for contraception refers to “bilateral vasectomy”. The two are completely different concepts.