1.What is varicocele? Varicocele is the dilatation, tortuosity and elongation of the venous plexus in the spermatic cord (Figure 18). Varicocele occurs mainly in young adult males and is rarely detected before the age of 10 years, with a prevalence of about 15% in the male population from the onset of puberty to adulthood, and accounts for 20-40% of male infertility. About 80-90% of primary varicocele occurs on the left side, which is related to the anatomical characteristics of the left testicular venous return. 2.What are the symptoms of varicocele? The main symptom of varicocele is a feeling of swelling and hidden pain in the scrotum, which can radiate to the groin area, lower abdomen or waist, and is aggravated after standing for a long time or exertion, and can be alleviated in a lying position. If the lesion is mild, it may not have any symptoms and is only detected during physical examination. 3.What are the hazards of varicocele? (1) Varicocele is often an important cause of male infertility, and it has been recognized that palpable varicocele affects fertility, and about 40% of primary infertility and 80% of secondary infertility suffer from varicocele. (2) After varicocele, due to the obstruction of blood return in the spermatic vein, the residual venous blood stagnates in the scrotum, which raises the temperature in the scrotum to an average of 0.6℃ higher than that of those without varicocele, leading to degeneration of spermatogenic tubules and affecting spermatogenesis; the blood circulation of testes and epididymis is affected, reducing the blood and oxygen supply to testes and epididymis, affecting the spermatogenesis of testicular varicocele, the interstitial cells endocrine function and sperm maturation in the epididymis; the regurgitated blood in the internal spermatic vein contains substances that impair testicular function, such as steroids, catecholamines and 5-hydroxytryptamine, which not only reduce testicular spermatogenesis but also cause premature sperm shedding; toxins in venous blood after varicocele on the left side affect right testicular function through the traffic vessels. All these changes can cause low sperm count, low viability and vitality, and eventually lead to male infertility. (3) Anti-sperm antibodies exist in peripheral blood and semen of infertile varicocele patients. Anti-sperm antibodies enter the testis or epididymis to interfere with the process of sperm production and maturation, resulting in a decrease in the number of sperm or adhesion to the sperm membrane, causing abnormalities in the morphology and function of sperm. (4) When suffering from varicocele, regardless of the severity of symptoms, you should go to the hospital in time, but not all varicocele patients cannot have children, the key is to see the degree of damage to the spermatogenic function of the testes. 4.When does varicocele need to be treated? The treatment of primary varicocele is determined by the degree of varicose veins, the presence or absence of clinical symptoms, the severity of symptoms, and the degree of impact on spermatogenesis. (1) If the symptoms are mild and have no effect on fertility, they can be left alone or the scrotum can be held up. (2) Regardless of the severity of symptoms, those who may or have been affected by fertility need prompt surgical treatment, including infertile couples; women with normal fertility or women who are infertile but can be treated; varicocele can be palpated on physical examination or confirmed by ultrasonography; and abnormal semen analysis. (3) Those who have obvious symptoms or have caused the testicles to become soft in texture, decrease in size or even atrophy should be treated actively. 5.What is the best treatment method for varicocele? (1) At present, there is no special medicine for varicocele treatment, but mainly relies on surgery to ligate the spermatic vein. (2) Surgical treatment mainly includes retroperitoneal spermatic vein high ligation, laparoscopic spermatic vein high ligation and microscopic spermatic vein ligation. Among the various surgical approaches and methods of varicocele surgery, microscopic fine surgery is the most effective and has the lowest postoperative complication rate. (3) With microscopic varicocele surgery, semen quality improves in 60 to 80% of patients after surgery, and the spontaneous conception rate is about 43% and 69% after 1 and 2 years, respectively, in the absence of infertility factors in the spouse.