Varicocele is a common male condition with a prevalence of about 15% in the normal population and about 35% in the infertile population. The anatomical characteristics of the walls of the internal spermatic veins make them susceptible to reflux disorders. The causes of varicocele vulnerability: the left spermatic vein injects into the left renal vein at a right angle; the left renal vein passes between the aorta and superior mesenteric artery; the left spermatic vein is located behind the sigmoid colon, and these anatomical features make the left spermatic vein susceptible to compression and increase the resistance to blood reflux. The entrance of the left spermatic vein into the left renal vein has a valve to prevent reflux, which can lead to varicose veins if the venous valve is underdeveloped and the smooth muscle or elastic fibers of the vein wall are weak. Varicocele is usually primary; of course, there are some secondary ones, and secondary ones are often due to perinephric tumor compression, resulting in obstruction of spermatic vein reflux. From the clinical point of view, the long vein masses in the scrotal area shrink or disappear after the primary varicocele patients lie down, but the secondary varicocele vein masses remain the same size; you can also do the urological ultrasound to see. The relationship between varicocele and fertility: varicocele is not necessarily sterile; however, the incidence of varicocele is higher in the infertile population than in the normal fertile population. Data showed that after varicocele surgery, semen quality improved in 70% of male infertility patients: sperm concentration improved in 51%, sperm motility improved in 70%, and sperm morphology improved in 44%. It also increased serum testosterone levels in patients with decreased serum testosterone in infertility, suggesting that both testicular spermatogenesis and supporting cell function improved after the procedure. Varicocele does not always affect fertility. The more severe the varicocele, the greater the correlation with impaired male semen quality and the more significant the improvement in semen quality after surgery. Furthermore, current studies suggest that varicocele surgery has a higher success rate (29.7% and 25.4%, respectively) and lower cost (the latter is about 3.4 times the cost of the former) than IVF/ICSI. Treatment of subclinical varicocele is also not recommended for patients with subclinical varicocele because of the lack of reliable clinical trials demonstrating that treatment of subclinical varicocele improves male fertility. In patients with oligospermia due to varicocele who have significantly elevated FSH, varicocele surgery is generally unlikely to improve fertility. Very few patients with non-obstructive azoospermia generally do not have enough sperm in their semen after surgery and often still require testicular sperm extraction (TESE), so azoospermia patients are not recommended for varicocele surgery. There are open microsurgery and laparoscopic varicocele surgery, but laparoscopic varicocele surgery has no significant advantages over the former, and some studies have even shown that its incidence and length of stay are higher than those of open microsurgery. Varicocele surgery is often performed due to male infertility, discomfort such as perineal swelling, or prophylactic treatment of varicocele during adolescence. However, in either case, there is a risk of no improvement in symptoms or unsatisfactory improvement after surgery, and preoperative caution must be exercised. Semen routine tests can be performed 4 months after varicocele surgery to assess the efficacy of the procedure, and it is advisable to monitor the changes of semen routine parameters 1 year after surgery or before the female partner becomes pregnant. The recurrence rate after varicocele surgery is 0.6% to 45%. For those who do not have obvious clinical symptoms, they can be observed; or they can use scrotal braces and wear body protectors. Azoospermia patients who have varicocele surgery may not help much in fertility. Varicocele grading: if varicocele can be seen, it is severe; if it cannot be seen, but can be palpated by palpation, it is moderate; if it cannot be seen and palpated, but can be palpated when doing Valsava test, it is mild.