I. Definition and classification of varicocele Definition: Varicocele refers to the dilatation, tortuosity and elongation of blood vessels in the trapezius plexus (venous plexus) of the spermatic cord due to stagnation of blood flow in the spermatic cord. 1.Primary varicocele: varicocele caused by anatomical factors and dysplasia. 2.Secondary varicocele: It is caused by the compression of the spermatic vein on the way back, common compression lesions are: renal tumor, ureteral tumor, retroperitoneal tumor, hydronephrosis, iliac vein obstruction, etc. 3, Subclinical varicocele: a minor varicocele that cannot be detected on physical examination but can be detected by ultrasound, nuclear scan or Doppler ultrasound. It is generally believed that a venous diameter of more than 2 mm can establish the diagnosis. Second, the etiology of varicocele (a) anatomical factors: 1, the left spermatic vein is long and enters the renal vein at a right angle, and the blood flow is subject to certain resistance. The left internal spermatic vein near the left renal vein has no valve, so the blood flows backwards easily. 2, the left internal spermatic vein is located after the sigmoid colon, which is easily compressed by feces in the intestine and affects the blood reflux. (2) Physiological factors: The sexual function of young adults is more vigorous, and the blood supply of scrotal contents is strong. In addition, long standing, increased abdominal pressure is also the pathogenesis of trapped factors. (C) Other factors: retroperitoneal tumor, renal tumor, hydronephrosis, etc. can cause symptomatic or secondary varicose veins in the spermatic cord by compressing the veins. The primary ones disappear quickly when lying down, while the secondary ones often do not disappear or disappear very slowly. Third, the harm of varicose spermatozoa Currently, it has been recognized that varicose spermatozoa can affect fertility and is one of the main causes of male infertility. The reasons for this include the following: 1. Blood stagnation in the spermatic veins leads to an increase in the local temperature of the testes and degeneration of the spermatogenic tubules, which affects spermatogenesis. 2. 2, Blood retention affects testicular blood circulation, and carbon dioxide accumulation in testicular tissue affects spermatogenesis. 3, The left spermatic vein reflux of renal vein blood contains such as steroids, catecholamines can cause vasoconstriction, resulting in premature sperm shedding. 4.Because there are abundant traffic branches in the bilateral intertesticular veins, the toxins in the left spermatic vein blood can affect the sperm production in the right testis. Diagnosis of varicocele (a) Clinical manifestations: Asymptomatic people are mostly detected by physical examination or due to infertility. Those with symptoms mostly show discomfort or pain in the affected scrotum, with pain radiating to the groin area and lower abdomen, aggravated when standing or after walking, and relieved after lying down and resting. (B) Grading: Grade 0: No symptoms of varicocele, Valsalva test does not appear. Grade Ⅰ: not obvious on palpation, but Valsalva test may appear. Grade II: dilated veins are easily palpable on palpation, but cannot be seen. Grade III: When standing, both the tortuous vein masses can be seen in the scrotal skin, like earthworms, which can be easily palpated. V. Treatment of varicocele (a) medication: compound carnitine, clomiphene, Tongjing, other herbal treatments * Non-surgical methods such as holding up the scrotum, local cold compresses and reducing sexual stimulation can be adopted for mild asymptomatic cases. (ii) Surgical treatment: Indications for surgery: 1. Infertility of varicocele, presence of abnormal semen examination, physical examination and medical history do not reveal other diseases affecting fertility. 2. Severe varicocele with obvious symptoms, the patient has the desire for treatment can choose surgical treatment. 3. Clinical findings of combined prostatitis, seminal vesicles. 4. Adolescent patients with varicocele, testicular pathological changes are progressive, so Adolescent varicocele with testicular volume reduction should be treated surgically as early as possible. Open surgical treatment 1, transinguinal canal spermatic cord ligation in high position: commonly used, because this area has more arteriovenous branches, rich lymphatic vessels, and close relationship between arteries and venous branches, so there is a possibility of testicular atrophy after injury. The recurrence rate after surgery is about 25%. 2, retroperitoneal high ligation: the recurrence rate is lower, but the postoperative period is prone to testicular sphingomyelia, scrotal edema and aseptic epididymitis laparoscopic surgery treatment: applicable to bilateral transperitoneal high ligation, obesity, history of inguinal surgery and postoperative complications of open surgery. Other treatments: including microscopic high ligation of spermatic veins and spermatic vein intervention embolization. Sixth, surgical complications: scrotal effusion or testicular syringomyelia: mostly related to lymphatic vessel injury. Testicular atrophy. Nerve injury: symptoms manifest as temporary numbness in the anterior medial thigh and anterolateral to the surgical incision, usually appearing within 10 days after surgery, with symptoms maintained for an average of about 10 months. Mostly due to injury to the ilioinguinal nerve and genitofemoral nerve. Injury to the vas deferens. Acute epididymitis. Omental emphysema and scrotal emphysema.