Varicocele is an abnormal dilatation, elongation and tortuosity of the trabecular plexus in the spermatic cord. The incidence of the disease is about 20% in the general male population. It rarely occurs before puberty and its incidence increases with age after puberty, probably related to physical growth, increased testicular size, and increased blood supply to the testes. Varicocele is a vascular lesion, mostly found on the left side. Patients with varicocele are often associated with decreased semen quality, making varicocele the number one cause of male infertility, accounting for 35% of patients with primary infertility and 50%-80% of patients with secondary infertility. The common causes of varicocele are: 1, people’s daily activities are often in an upright posture, the venous blood in the spermatic cord must overcome its own gravity to return from the bottom up; 2, weakness of the vein wall and adjacent connective tissue or underdevelopment of the levator muscle, weakening the dependence around the veins in the spermatic cord; 3, the left internal spermatic vein has a long stroke, is located behind the sigmoid colon, and enters the renal vein at a right angle. The left renal vein is located between the aorta and superior mesenteric artery and may be clamped by both arteries to increase the reflux resistance; 5. The right common iliac artery may compress the left common iliac vein and affect the reflux of the left internal spermatic vein. Patients with spermatic varicoceles usually have no obvious symptoms and are mostly found during routine physical examinations, or painless earthworm-like masses in the scrotum during self-examinations, or during visits to the doctor for infertility. Some patients may have symptoms such as cramping, vague pain and discomfort, which may be aggravated after prolonged standing or walking and may be relieved or disappear after lying down. It may be combined with varicose veins of the lower extremities and hemorrhoids. According to the physical examination, varicocele may be classified into four grades: grade III: the surface of the scrotum is visible with the naked eye as worm-like tortuous veins when the patient stands; grade II: dilated veins can be palpated; grade I: palpation is not obvious, but dilated veins can be palpated when the patient holds the breath and increases abdominal pressure; grade 0: no symptoms of varicocele and varicose veins cannot be palpated even when the patient holds the breath and increases abdominal pressure. veins. How does varicocele affect male fertility? Varicocele is associated with semen abnormalities, testicular atrophy, reduced testicular perfusion and testicular spermatogenic dysfunction, etc. The specific mechanisms may be as follows Varicocele can increase the temperature of the testes, leading to spermatogenic disorders, resulting in a decrease in testosterone synthesis by testicular interstitial cells. 2, High pressure. Elevated spermatic vein pressure leads to insufficient testicular perfusion and hinders testicular metabolism. 3.Lack of oxygen. Poor venous blood return caused by varicocele can lead to testicular stasis and hypoxia, carbon dioxide accumulation, interfering with the normal metabolism of the testes, affecting spermatogenesis and maturation. 4, the influence of toxic substances. In varicocele, the blood returning from the adrenal gland may flow back along the spermatic vein, bringing the metabolites secreted by the adrenal gland and kidney such as steroids, catecholamines, 5, hydroxytryptamine and other substances into the spermatic vein, leading to the impairment of sperm maturation in the testis. The treatment of primary varicocele should be differentiated according to the presence or absence of infertility or abnormal semen quality, the presence or absence of clinical symptoms, the degree of varicose veins and the presence or absence of other complications. Treatment methods include surgical and non-surgical treatments. Surgical methods include traditional open surgery, microsurgery, laparoscopic surgery and interventional embolization. Non-surgical methods include medication, psychological intervention, scrotal support, hypothermia, dietary modification, etc. Secondary varicocele should be actively sought and treated for the primary disease.