In some patients with abnormal sperm quality, a doctor’s examination will reveal “worm-like” cords in the scrotum, which are actually tortuous, dilated veins, clinically diagnosed as varicocele. Patients may have a feeling of swelling and discomfort, or they may not have any symptoms, but they are detected by the doctor because of infertility. According to statistics, the prevalence in patients with male infertility can be up to 40%, more common on the left side, and higher in men with secondary infertility. The diagnosis is usually confirmed by the doctor’s manual examination, and ultrasound examination can reveal a significant thickening of the internal diameter of the internal spermatic veins. There are usually three degrees: degree 3 is the most obvious, where the dilated veins can be seen protruding from the scrotal skin when the patient is standing; degree 2 cannot be seen, but the dilated cords can be palpated on palpation; degree 1 is not obvious on initial examination, but the Valsalva test (breath-holding) can be present. Sometimes the doctor can palpate but the ultrasound does not reveal dilated veins, which may be due to the following reasons: the room temperature is colder or the scrotal temperature is lowered with the coupling agent used for the examination, so the blood vessels are constricted; or in less severe varicocele, the pressure in the blood vessels is lowered in the lying position and without breath-holding, so the dilatation of the blood vessels is not obvious. Varicocele can cause oligospermia, hypospermia, and teratospermia. The causes of sperm quality abnormalities due to varicocele are: 1. Increased local temperature due to venous reflux disorders in the testes. 2. 2, Increased pressure in the spermatic vein, metabolic products of the testes cannot be discharged, and even metabolic products of the kidneys reflux to the testes. 3, Damage the function of testicular interstitial cells to produce androgens, which are especially important for spermatogenesis in the testes. 4. Varicocele on one side can affect the spermatogenic function of the opposite testicle. What are the methods of surgical treatment? 1.Traditional retroperitoneal high ligation of the spermatic vein. A small incision is made on the left side of the patient’s lower abdomen (on the side of the disease) and the internal spermatic vein is found and ligated and cut. In this position the vessels have basically gathered into 1, so the operation is relatively simple. 2.Laparoscopic high ligation of the spermatic vein. The surgery is completed by making 2-3 small holes in the belly, the postoperative wound is not obvious, and it can treat varicocele on both sides at the same time. 3.Microscopic spermatic vein ligation. Because this procedure has the most obvious improvement on sperm quality compared to other methods, it is now the routinely recommended method abroad. The incision is made in the outer inguinal ring where pubic hair can cover, and the postoperative wound is not obvious. The artery, vein and lymphatic vessels can be clearly distinguished by microscopic magnification 10 times, so the artery and lymphatic vessels are protected and only the vein is treated, and postoperative complications will be reduced. Do all varicocele require surgery? No! Surgery is considered in the following cases: 1. Varicocele causes abnormal sperm quality, resulting in infertility. 2.Scrotal swelling and discomfort affects life. 3.Severe varicocele with testicular atrophy although they have not reached marriage age. A few patients with azoospermia may also have sperm through varicocele surgery. If the female partner has incurable infertility factors or normal semen examination, there is no urgency for surgery. Patients who do not undergo surgery can be treated medically to improve sperm quality, but may have little effect on the recovery of varicocele.