1.What is varicocele? Varicocele is a common disease in young adults, which refers to the dilatation, tortuosity and elongation of the vasculature of the seminiferous plexus (plexus of veins) due to the stagnation of blood flow in the spermatic cord. The prevalence is 10 – 15% in the male population and about 35% in the infertile population, and animal studies and clinical studies have shown that varicocele causes progressive testicular function decline. 75% – 85% of patients with varicocele cause secondary infertility. There is a feeling of swelling or pain in the affected scrotum or testicles, and the scrotum is enlarged. The symptoms are more pronounced when walking or standing. It is best to go to the hospital for a detailed examination to confirm whether the varicocele is present. 2.Who needs surgery? ①If the varicocele is infertile, there are abnormal semen examination, no other diseases affecting fertility are found in medical history and physical examination, normal endocrine examination, and no abnormal findings in female fertility examination, regardless of the severity of varicocele, as long as the diagnosis of varicocele is established, surgery should be performed promptly. ②Severe varicocele with obvious symptoms, such as more standing that is to feel the pain of scrotal swelling, etc., physical examination found testicular obvious shrinkage, even if there has been fertility, the patient has the desire for treatment can also consider surgery. Clinical observation shows that the incidence of prostatitis and seminal vesiculitis in patients with varicocele increases significantly and is twice as high as normal people, so if the above two diseases exist at the same time and prostatitis is not cured for a long time, varicocele surgery can be chosen. ④For adolescent varicocele, since it often leads to pathological and progressive changes in the testes, it is now advocated that adolescent varicocele with testicular volume reduction should be treated with surgery as early as possible to help prevent infertility in adulthood. ⑤ For patients with mild varicocele, if the semen analysis is normal, they should be followed up regularly (every 1 – 2/year), and once there is abnormal semen analysis, testicular shrinkage and texture softening, they should be operated promptly. (6) For patients with varicocele accompanied by oligospermia due to non-obstructive factors, it is recommended to perform testicular biopsy and varicocele surgery at the same time to help perform assisted reproduction. 3.What is the surgical option for varicocele? There are conventional open surgery, laparoscopic surgery and microscopic spermatic vein ligation. The first two surgical methods are prone to leakage, testicular atrophy, high recurrence rate after surgery and high incidence of syringomyelia. Microscopic spermatic vein ligation magnifies the tissue up to 10–20 times and can precisely identify and separate the arteries, veins, lymphatic vessels, vas deferens and nerves of the spermatic cord. (1) The small side branches of the veins can be clearly seen, especially the veins around the levator muscle and arteries, the lateral veins outside the spermatic cord, and the testicular leading veins, etc. If these small side branches are not tied, they will expand over time and lead to recurrence after surgery; (2) The testicular arteries are clearly distinguishable, so as to prevent testicular atrophy after surgery due to mistyping; (3) The lymphatic vessels are clearly distinguishable, so preserving them can avoid syringomyelia after surgery. This procedure has become the gold standard procedure for the treatment of varicocele in the international medical community.