1. Which varicocele requires surgery? (1) Abnormalities in at least one semen parameter such as: viability, density, malformation rate, etc. It is now believed that sperm DNA integrity and reduced acrosome enzyme activity may also benefit from spermatic varicose surgery. (2) Discomfort such as soreness and slight pain in the affected scrotum, if the pain is severe, it is usually not caused by spermatic varicose. If the varicocele is combined with scrotal discomfort on the affected side and/or abnormal semen in at least one parameter, and other etiologies are ruled out, then surgery should be considered, and surgery is not recommended for subclinical varicocele. In adolescents with combined varicocele, the classic indication for surgery is that the development of the affected testis is compromised, but the specific assessment may vary from one surgeon to another and is inconsistent between Europe and the United States, so a careful outpatient evaluation is required. 2. Is varicocele always a cause of infertility or scrotal discomfort? Not necessarily, but if other common causes are excluded, 60-70% may be. 3.Is surgery always effective? The effectiveness rate is usually around 60-70%, and Marc Goldstein, the world’s leading surgeon, only had a pregnancy rate close to 70% two years after surgery. This is often not because the surgery itself is unsuccessful, but sometimes varicocele is not the cause, and it is difficult to determine if it is the cause before surgery. Likewise, the efficiency of surgery for scrotal discomfort is about the same. I usually present this to patients preoperatively, not to pass the buck, but because medicine has stages and limitations and is not a panacea, which is the state of medicine. We can proudly say that we offer the best technology at this stage, but not the almighty Dan technique. Many patients want their doctors to give a straightforward conclusion: to do or not to do? In my opinion, today, with a much higher degree of education for all, it makes the most sense to give patients the right to be fully informed, to fully understand the current state of medicine and its shortcomings, and to make a choice together. 4. Now the new semen standards are very different from the fourth edition, which one should be used? The new standard and the old standard of semen parameters are used at the same time, and there were no Chinese semen parameters when the new standard was formulated, so there is no definite conclusion on which standard should be used for Chinese people. It is generally recommended to make a comprehensive judgment in an outpatient clinic before deciding on a treatment plan. For patients who have never had a sexual partner or who have not tried to have a baby for more than 6 months, I usually put a stricter indication for the surgery, after all, abnormal semen parameters do not mean that the partner cannot get pregnant. 5. What is the procedure, the number of days of hospitalization, and the cost? Is it covered by medical insurance? We generally use microscopic surgery, unilateral microscopic procedure is about 30-45 minutes, but there are also difficult cases of bilateral surgery more than 3 hours, generally hospitalized for 3-5 days, now because I transferred from the Department of Urology to the Department of Infertility and Sexual Medicine, there is no general ward for the time being, the surgery can only be done in the special ward, the total cost is higher, you can consult my assistant Dr. Yang Xiaojian for details. Some of the laparoscopic procedures will cost more than about 10,000 RMB. However, in practice there are fluctuations between individuals and it is difficult for me to provide an absolute value. The medical insurance issue varies from place to place, so I cannot answer it, so you can consult your local medical insurance office. 6. Common complications? Recurrence, edema and testicular atrophy. However, the recurrence rate of our microsurgery is less than 2%, edema is very rare, and we have not seen any cases of testicular atrophy yet. 7.Does the scrotal tortuosity and sagging disappear after surgery? The principle of surgery is to block the venous reflux, not to remove the veins in the scrotum, which will easily lead to edema and testicular atrophy, so the tortuosity of the scrotum is usually reduced gradually after surgery, and some of them can disappear, but not all patients have this effect. In the past, the operation would usually suspend the levator muscle upward a bit, but it has been abandoned now, so the operation no longer deliberately solves the problem of ptosis. 8. Will the quality of semen decrease after surgery? Is it possible that the symptoms of discomfort will worsen? Theoretically, yes, but it is very rare and may be seen in two cases: (1) post-operative edema and atrophy, which are related to the surgery; (2) varicocele itself is not the cause, but the cause still exists, such as radiation, environmental hormones, other etiologies, etc. (3) Varicocele is not the cause of scrotal discomfort. 9.Is there any other treatment for varicocele? What are the advantages and disadvantages? These include laparoscopic techniques, microscopic techniques (subepidural or transinguinal, we decide the route depending on the height of the epidural ring of the patient, transinguinal is usually chosen if the epidural ring is too low), open techniques (subepidural, transinguinal, retroperitoneal routes), interventional techniques (cascade or retrograde approach), etc. Objectively speaking, all of these modalities are used by physicians, and it is difficult to determine the absolute advantages and disadvantages. The surgical approach and results also depend on the experience of the operator, with more recent comparative studies supporting the microscopic technique. As for treatments other than surgery: medication will be effective in some patients, and a small percentage of patients who do not receive any treatment can have a pregnancy, but overall studies show that surgery is better than medication and medication is better than no treatment. 10. Do both sides of the varicocele have to be done? If there is a problem with the quality of semen, we do both sides; if you are seen for symptoms, we do the symptomatic side; these refer to clinical varicose veins, subclinical varicose veins (no findings on physical examination, only reflux on ultrasound) do not advocate surgery, but there is controversy in this area. 11. Are there any patients who request surgery and you refuse? Yes, some patients do not have clear indications for surgery (such as some infertility), and some patients with symptomatic complaints, whose degree obviously cannot be explained by varicocele alone, have a more obvious psychological color or anxiety, and some even say that I am “irresponsible” because of this, and one patient even grabbed me by the shirt and said: “I just want you to give One patient even grabbed my clothes and said: “I just want you to do the surgery for me, don’t worry about anything else! In fact, hospitals are places where people are treated and saved, so how can they be too busy for surgery? In fact, the hospital is a place to treat patients, which will be too many patients for surgery. Only, medicine has its own standards, I hope we understand and understand. I actually recommend surgery to no more than half of the patients who claim to have spermatorrhea and come to me for surgery after careful evaluation.