Varicocele is one of the most common diseases in male clinic, mostly seen in young and middle-aged men, with a prevalence of 15%, 40% of male infertility patients, and 20% of combined pain and discomfort. It is an important factor known to cause male infertility. Our male department carries out more than 300 cases of microscopic spermatic vein ligation every year, which can significantly improve the quality of patients’ semen and relieve pain. It has attracted extensive attention from patients and the media, and a large number of patients have also consulted on surgery-related issues. The answers to the frequently asked questions are as follows: 1. Why does varicocele cause male infertility? At present, it is believed that the mechanism of male infertility caused by varicocele is related to abnormal sperm quality, reduced testicular volume, decreased testicular perfusion and testicular dysfunction. However, the exact mechanism causing infertility has not been fully understood so far, and it is generally believed that it may be related to the following factors: A increased intratesticular temperature; B hypoxia; C renal and adrenal metabolite reflux; D reactive oxygen species injury; E testicular microcirculation disorders; F nitric oxide (NO) mechanism; G other: including increased reproductive toxins, increased levels of antioxidants, decreased activity of DNA polymerase, the presence of sperm-binding immunoglobulins, anti-sperm antibodies and other comprehensive diseases G other: including increased levels of reproductive toxins, decreased activity of DNA polymerase, the presence of sperm-binding immunoglobulins, anti-sperm antibodies, and other comprehensive pathophysiologic changes, which may ultimately lead to testicular spermatogenesis disorders and gradual testicular hypoplasia, resulting in male infertility. 2. Can varicocele cause sexual dysfunction and inflammation of the reproductive system? There is no evidence that varicocele can directly cause sexual dysfunction or reproductive system inflammation. However, varicocele may affect the size of the testicles over time, and androgen (testosterone) is secreted by the testicles. Reducing the size of the testicles may lead to a decrease in androgen in the body, which may cause a decrease in libido and so on. Therefore, sexual dysfunction is possible only when the size of testicles is significantly reduced. 3. Does this condition get progressively worse without treatment and is there a risk of potentially serious diseases (e.g. cancer)? Spermatocellular veins can definitely get progressively worse if left untreated, but there is no potential for serious disease and it is never cancerous. 4. Do I have to have surgery to restore my reproductive function? Varicose veins are known to be a very definite cause of decreased semen quality. Although medication may temporarily improve semen quality, the efficacy of the treatment is not very certain and is likely to be temporary. We often use the analogy that the spermatic vein is a water pipe, and if the pipe expands due to various reasons, it is impossible to shrink it by any means. In the same way, if the spermatic vein is dilated, no medication can reduce its size. Therefore, surgery is necessary to restore reproductive function. 5. Is surgery necessary for all varicocele patients? Surgery is not necessary for all varicocele patients. Before understanding the indications for surgery, it is necessary to understand the clinical grading criteria of varicocele: Clinical degree I: the varicose veins are not obvious on palpation, but can be felt when the patient holds his breath and increases the abdominal pressure; Clinical degree II: the varicose veins can be felt on palpation without holding his breath but their appearance is normal; Clinical degree III: the varicose veins are like clusters of worms, which are extremely obvious on palpation and visualization. Spermatic vein ligation is necessary in the following cases: patients with degree II-III or above combined with oligozoospermia; patients with degree I-II combined with oligozoospermia or oligozoospermia without significant improvement after 3 months of conservative treatment; patients with degree I-III combined with scrotal distension, pain and discomfort that affects the quality of life. 6. Is it necessary to do it for patients who have no need for reproduction? Varicocele may lead to two consequences, one is the decline of semen quality, the other is the localized swelling and discomfort of the scrotum and testicles, for patients who do not have the need to have children, if there are obvious pain symptoms, it is also necessary to do the surgery. 7. What kind of surgery is used to treat varicocele and is it risky? At present, there are three main types of surgery for varicocele: open surgery through the groin, laparoscopic spermatic vein ligation and microscopic spermatic vein ligation. Microscopic spermatic vein ligation can ligate the vein more thoroughly, preserving the arteries and lymphatic vessels, with obvious improvement in semen quality after surgery, fast recovery, low recurrence rate and fewer complications. It has obvious advantages over traditional surgery and has become the gold standard for varicocele surgery. At the same time, microscopic varicocele ligation is less traumatic and the risk of surgery is minimal. 8. How long does the surgery usually take and how much does it cost? Microscopic varicocele ligation usually takes about 1 and a half hours for unilateral surgery and 2 hours for bilateral surgery. The total cost is about 8,000 RMB for unilateral and 10,000 RMB for bilateral. 9. Is there a high recurrence rate after surgery? The incision of microscopic spermatic vein ligation is made under the external ring, which has very few vein traffic branches, and the operation under the microscope can ligate the vein more thoroughly to avoid leakage, so the recurrence rate is also very low. At present, the recurrence rate of microscopic spermatic vein ligation is ≤1%, which is significantly lower than the recurrence rate of about 15% of the other two surgical methods. 10. Do infertility patients need medication after microscopic spermatic vein ligation? Microscopic spermatic vein ligation is obviously able to solve the fundamental problem of oligozoospermia, however, there is a process of recovery of semen quality after the operation, generally speaking, the improvement of semen in 3-6 months after the operation is the most obvious, and it is better to use some spermatogenesis medication during the process, Chinese medicine has obvious advantages in improving semen quality, therefore, we suggest patients to cooperate with traditional Chinese medicine treatment for 3 months after the operation.