I. When is treatment of varicocele necessary? The American urology association (AUA) report on varicocele and infertility clearly states the indications for treatment, i.e., patients with varicocele who have a fertility requirement must meet the following four criteria: 1) the varicocele is palpable on physical examination of the scrotum; 2) the couple is diagnosed as infertile; 3) the female partner has normal fertility or a treatable cause of infertility; 4) the male partner has abnormal semen parameters or abnormal sperm function tests. 3. the female partner has normal fertility or a treatable cause of infertility; 4. the male partner has abnormal semen parameters or abnormal sperm function tests. Those who are not currently planning to have children but need to have children in the future and have palpable varicocele with semen abnormalities also need to be treated. Treatment of varicocele (VC) can significantly improve semen quality, increase the chances of natural fertility or improve the success rate of assisted reproductive technology applications. In addition, the effectiveness of treatment of VC in non-obstructive azoospermia has been a major concern. In this regard, the results of existing studies are relatively consistent, namely, after sclerotherapy or surgery for non-obstructive azoospermia or severe oligo- and hypospadias with VC, some of them can improve testicular spermatogenesis and obtain enough sperm for assisted reproduction treatment or even achieve spontaneous conception. The current study concluded that preoperative testicular pathology is the best indicator to judge the prognosis of VC treatment, only patients with supportive cell syndrome and sperm maturation stagnation at the spermatocyte stage have no improvement in testicular spermatogenic function after treatment; while azoospermia patients with sperm maturation stagnation at the spermatocyte stage or low spermatogenic function have half the chance to improve their spermatogenic function after surgery. Second, the treatment methods of varicocele varicocele treatment methods include sclerotherapy (cis and retrograde), embolization, open surgery (scrotal incision, inguinal incision and high ligation, etc.), laparoscopic surgery and microsurgical ligation, etc. Since there is no definite evidence to determine which of these modalities is superior or inferior in improving fertility, the choice of treatment modality is based on the recurrence rate and complications: 1. Microsurgery has a low recurrence rate, few complications and short recovery time, and our hospital is discharged after only 1 day of hospitalization, but requires high surgical skills and long operation time; 2. Laparoscopic surgery has the advantage of better magnification and helps avoid damage to the testicular artery, but there is no advantage in terms of recurrence rate, complication rate and treatment cost; 3, cis sclerosis compared with open surgery and laparoscopic surgery, less damage, lower cost, better results, less complications, more suitable for adolescent or pediatric VC patients; 4, open surgery choose inguinal route or retroperitoneal route, traditional classical, low cost of surgery, possible edema of scrotum, slow recovery from painful incision 5 .Subinguinal internal spermatic vein ligation by microsurgery technique for boys under 18 years old is safe and effective, with less complication rate than other procedures. III. Evaluation of the efficacy of varicocele Since VC treatment is mainly used as a means of treating male infertility, the criteria for evaluating the efficacy are nothing but the improvement of testicular spermatogenesis/ semen quality or the achievement of fertility. Post-operative follow-up of semen quality and pregnancy of the spouse will be conducted, and semen will be rechecked after 2 months. D. Precautions after spermatocele surgery 1. avoid wet water at the surgical site within one week after surgery; 2. review semen after 2 months with medication after surgery; 3. avoid sexual intercourse for 5 weeks; 4. change medication on 2-3 days, surgical sutures gradually fall off about one month after surgery, no need to remove sutures; 5. wear tight underwear after surgery to reduce scrotal edema; 6. -The incidence of varicocele is a common male disease, about 15% in the normal population and about 35% in the infertile population. Causes of varicocele: The anatomical characteristics of the walls of the veins in the spermatic cord make them susceptible to reflux disorders. The causes of varicocele susceptibility: 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 return. The entrance of the left spermatic vein into the left renal vein has a valve to prevent reflux, which can lead to varicocele 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. Clinically, primary varicocele is seen to shrink or disappear after lying down, but secondary varicocele remains the same size; it can also be seen by urological ultrasound. Research data shows that 60 to 80% of semen quality is improved in varicocele patients after surgery, and the postoperative conception rate is 20 to 60%; it also improves serum testosterone levels in patients with decreased serum testosterone in infertility, which indicates that testicular spermatogenic function and supporting cell function are improved after surgery. Varicocele does not always affect fertility. Varicocele surgery is often due to male infertility, uncomfortable symptoms such as perineal cramping, 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. The recurrence rate after varicocele surgery is 0.6% to 45%. For those with insignificant clinical symptoms, they can be observed; or scrotal braces and body protectors can be used. Varicocele surgery in patients with azoospermia may not help much with 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.