I. What is varicocele? Varicocele refers to the dilation and tortuosity of the trapezius plexus caused by obstruction of spermatic venous reflux or venous valve hypofunction. It is most common in young and middle-aged men, and is relatively rare before puberty. It accounts for nearly 20% of the male population and 35% of the infertile population. It usually occurs more often on the left side. Why does varicocele occur? Because the spermatic veins in the scrotum are located in the low hanging part of the body, they are more prone to venous reflux disorders and consequently varicose veins. Specifically, there are congenital and acquired factors. The congenital factors are also known as anatomical factors, which include the following factors: the left spermatic vein is long and converges at right angles to the renal vein, which is subject to some resistance to blood flow. The left internal spermatic vein near the left renal vein does not have a valve, so the blood flows backwards easily. The left internal spermatic vein is located behind the sigmoid colon and is susceptible to compression by feces in the intestine, which affects blood return. Secondary factors, including all factors that cause a continuous increase in abdominal pressure, including prolonged standing, prolonged sitting, chronic constipation, chronic coughing, prolonged weight bearing, playing some wind instruments, etc., all of these factors increase the resistance to vascular reflux and become a trigger for the formation of varicocele. So varicocele is a chronic course of disease with the combined effect of congenital and acquired factors. What should be done when varicocele occurs? Most of the varicocele belongs to the asymptomatic spermatic varicocele, and after excluding its potential functional damage, we can completely wait and see what happens, and the change of the degree of this varicocele and the damage of the varicocele on the testicular function is extremely slow progress in most cases, so we have plenty of time to observe it. Usually we evaluate every six months to a year. The evaluation will include local ultrasound, sex hormone levels, and semen routine (for those with fertility needs). For those who have symptomatic varicocele, the first step is to avoid triggering factors such as prolonged standing and sitting, and all factors that increase abdominal pressure. This includes weight training, prolonged coughing, constipation, etc. And if the symptoms are more obvious, you can take oral medications, such as Myclobutanil, Diosmin to improve the symptoms, knowing that the role of drugs is to improve the symptoms, not to treat varicose. Later on, we will talk about when the ultimate means of surgery is needed. In what cases do varicocele require surgery? Most varicose veins do not require surgery. So under what circumstances does surgery become necessary? Simply put, that is, if the varicocele appears to be a problem for our health, then it needs further attention to the point of surgical treatment. The indications for surgical treatment include the following: one: local symptoms are obvious and the patient is unwilling to take oral medication or the medication does not improve well. Secondly, there is a change in testicular morphology and texture, with the patient’s testicle volume being 20% or more smaller than the opposite side and the texture being softer than the opposite side. Thirdly, there is damage to testicular function, such as decreased semen quality and low testosterone levels. For adolescent patients with varicocele, since semen specimens cannot be obtained, we determine the need for surgery mainly by symptoms and testicular volume.