Every day, patients and their families ask us the same question: Doctor, I know I should have surgery for varicocele, but is it very invasive? What is the best type of surgery? Are there any complications with the surgery? Since this question is very common, today we will talk specifically about the surgical treatment of varicocele. First of all, we should understand that varicocele in men is the most important cause of male infertility (oligo-, oligo- and malformed spermatozoa), why does varicocele cause this condition? We know that the spermatic artery blood brings oxygen and nutrients to the testes, and the spermatic veins take away the waste and carbon dioxide produced by the metabolism of the testes, so as to ensure the normal metabolism of the testes and the production of sperm. Varicocele is a pathological dilatation of the veins, the venous blood exists in these vessels and cannot flow back normally, so naturally it cannot take away the waste and carbon dioxide produced by testicular metabolism, over time, the testicles will be in a chronic oxygen and nutrient deficient environment for a long time, naturally the sperm production and sperm production ability of the testicles will be affected, so the best treatment is to ligate the varicocele. The best treatment is to ligate the varicose veins and let the blood flow back through the normal veins, and the disease will be cured! Note that the varicose veins are ligated, while the normal veins, arteries and vas deferens are not damaged, which is not the same as what we call sterilization surgery – vasectomy. So what percentage of patients recover semen quality after varicocele surgery? The literature reports that approximately 2/3 of sperm parameters improve after varicocele correction, so surgery is the primary treatment for patients with severe varicocele or with semen quality that is already declining. The traditional varicocele surgery is performed by cutting a large 4-5 cm long incision in the patient’s groin, which is only carried out in some primary hospitals, but most large hospitals no longer use this more invasive surgical method. At present, some better hospitals generally use laparoscopic spermatic vein ligation, which has some advanced features compared to the traditional incision, such as no more incision, just three holes in the patient’s stomach to complete the operation, fast recovery, small scar left on the body, more beautiful, but this surgery also has great disadvantages, the first disadvantage The first disadvantage is that the surgery is performed through the patient’s abdominal cavity, so there is a risk of intraoperative damage to the intestines and bladder and postoperative complications such as intestinal obstruction; the second disadvantage is that the chance of recurrence of varicocele is relatively high after this surgery, and some literature reports that the recurrence rate after surgery can reach 1/4. So what is the best surgery? The best surgical procedure for varicocele is microscopic surgery, which makes up for almost all of the defects of the above 2 surgical procedures, and is very invasive, requiring only an incision of about 1 cm to complete the surgery. What’s more, the recurrence rate of varicocele after microscopic surgery is only about 1/100, which is much lower than the recurrence rate of 1/4 of the above two procedures. It is because of the advantages of microscopic spermatic vein ligation surgery such as less trauma, faster recovery, lower recurrence rate, and the fact that the postoperative incision is almost undetectable and aesthetically pleasing that it has become the “gold standard” for the treatment of varicocele in developed countries around the world such as Europe and America. Unfortunately, when I received my microsurgery training in 2006 to perform urological microsurgery, this procedure was already very popular in the United States, and there were almost no doctors in China who could perform this type of surgery, and even now, due to the small number of highly trained urological microsurgeons in China, this procedure is still only performed in a few medical centers or hospitals. To conclude with a brief description of our situation, my patients usually need to make an appointment for 1-3 weeks to receive the procedure, and on average, I personally perform nearly 200 similar procedures each year.