Varicocele is generally considered to be a progressive disease. This means that the disease worsens progressively and brings a series of problems such as: scrotal cramps, testicular atrophy, and abnormal semen parameters. However, not every patient with varicocele has typical clinical symptoms in clinical practice. Some patients have no painful symptoms although their varicose veins are very severe; many patients with varicocele have never been examined and have had their own children without treatment. At the same time, we do find many patients in the clinic do find varicocele only further because they are infertile for several years after marriage and have abnormal semen parameters. After the varicocele surgery, the semen parameters improved and many of these patients had their own children soon. If you have varicocele, do you need surgery or not? We think: first of all, if the quality of semen due to varicocele is poor and affects fertility, surgery should be performed. Secondly, surgery is needed if the painful symptoms are severe and seriously affect the quality of life of the patient. In addition, we found that some patients have varicocele and chronic prostatitis and chronic vesiculitis at the same time, and the symptoms of chronic prostatitis in these patients are not cured for a long time, so the surgery of varicocele may reduce or benefit the treatment of chronic prostatitis and other diseases. It is also best to operate on adolescent patients with varicocele if the varicocele is found to be affecting the patient’s testicular development. Finally, you may have varicocele but currently have none of the above mentioned problems, we still recommend that you have regular checkups and if at any time you find signs such as smaller testicles and a drop in testosterone on sex hormone tests, we recommend that you have surgery. What are the surgical options for varicocele? The first one is open spermatic vein ligation, which can be done either in the groin or retroperitoneally. One of the most classic procedures is the high spermatic vein ligation (retroperitoneal). This is because the higher the site, the less the number of spermatic veins. However, because they have to be ligated at a high level (retroperitoneal), the surgical incisions are usually large and the postoperative recovery is slow. In addition, the arteries (which feed the testes) and lymphatics in the spermatic cord are often ligated together during surgery, leading to their higher postoperative complications. Next is laparoscopic spermatic vein ligation. In patients with bilateral varicocele, the procedure can ligate both sides simultaneously, and experienced surgeons can preserve the arteries and ligate only the veins. However, intraoperative lymphatics are often not preserved, and the use of laparoscopy leads to a relatively high cost of the procedure and is still somewhat more invasive than microscopic surgery. Finally, microscopic spermatic vein ligation is considered the best procedure. Because of the magnification of the microscope, very fine vessels, lymphatic vessels and other tissues can be identified and the incision does not need to be made high (retroperitoneally), the most common sites for the procedure are the subinguinal and inguinal incisions. And the incision is very small, about 1 cm to 1.5 cm, in the area covered by pubic hair. The microscopic procedure provides excellent ligation of all the internal spermatic veins while preserving the arteries and lymphatics, thus offering significant advantages in many aspects, both in terms of surgical outcome, postoperative complications and length of hospital stay. The disadvantage is that this procedure relies on a high quality operating microscope and requires a high level of microsurgical skill on the part of the surgeon. At present, our hospital mainly uses microscopic spermatic vein ligation, which is characterized by rapid postoperative recovery, short hospital stay, low recurrence rate, and few postoperative complications.