Varicocele is one of the common clinical diseases in male medicine, mostly seen in young and middle-aged men, with an incidence of 15%, 40% in male infertility and 20% in combined pain and discomfort. It is an important factor known to cause male infertility. Does it have to be treated surgically? Not all patients with varicocele need to be treated surgically. Before understanding the indications for surgery, it is necessary to understand the clinical classification criteria of varicocele: varicocele can be classified as clinical or subclinical according to its severity. The clinical type is generally classified as mild, moderate and severe while the subclinical type of varicocele cannot be seen or felt and can only be detected by ultrasound. If the diameter of the spermatic vessels is greater than 1.8-2 mm when the patient is holding his breath, the diagnosis of varicocele can be made by ultrasound. If varicocele is found, moderate and mild ones can be left untreated and only observed, as well as improving poor lifestyle, reducing sedentary lifestyle, strengthening exercise, and stop letting poor lifestyle habits affect the function of testicles. However, in case of severe varicocele, surgery is the most effective treatment, so there is no need to wait until the semen is abnormal. Patients with severe varicocele may experience testicular atrophy, but the progression of testicular atrophy can be slow, and it usually takes three, five or ten years before a person experiences a change in the size of the testicles. What kind of varicocele requires surgery? Although varicose veins affect fertility, not all varicose veins require surgical treatment. Surgery can be considered for the following clinical indications: if the varicocele can be clearly identified by palpation or even visual examination of the scrotum or if the symptoms are so severe that they affect the quality of life or work, surgery can be considered; for male infertility, i.e., patients with oligozoospermia, surgery can be considered regardless of the degree of varicocele; however, for severe semen quality abnormalities, sometimes surgery is not always an option. For adolescents with varicocele, since varicocele can lead to pathological and progressive changes in the testes, it is currently advocated that adolescents with varicocele and testicular volume reduction should be treated with surgery as early as possible to help prevent infertility in adulthood. If the semen analysis is normal, patients with mild varicocele should be followed up regularly, and in case of abnormal semen analysis, testicular shrinkage and softening of the testicles, surgery should be performed promptly. Is it necessary for patients without fertility needs? Varicocele may lead to two consequences, one is the decrease of semen quality, and the other is the localized painful and discomfortful swelling of the scrotum and testicles. For patients without fertility needs, surgery is also necessary if they have obvious painful symptoms. Do patients with infertility need medication after surgery? Microscopic spermatozoal vein ligation can obviously solve the fundamental problem of oligozoospermia, however, there is a process for the recovery of semen quality after surgery, generally speaking, the improvement of semen is most obvious 3-6 months after surgery, and it is better to use some spermogenic drugs during this process. Chinese medicine has obvious advantages in improving semen quality, therefore, it is recommended that patients cooperate with Chinese medicine for 3 months after surgery.