1.What is varicocele? Varicocele is an abnormal expansion, lengthening and tortuosity of the trapezius plexus in the spermatic cord. It is a common disease in men, mostly in young adults between the ages of 20 and 30, with an incidence of about 10% to 15% of the male population. 2.How do varicocele occur? Varicocele is caused by poor blood flow in the spermatic vein due to various reasons and is formed in the veins. It occurs mostly on the left side and accounts for 80% to 90% of the total incidence. Possible reasons are: ① The left internal spermatic vein has a long stroke and enters the left renal vein at a right angle, with high intravenous pressure; the left renal vein is located between the aorta and the superior mesenteric artery, and the lower part of the left internal spermatic vein is located behind the sigmoid colon. These anatomical features make the left spermatic vein vulnerable to pressure and increase the resistance to blood return. ②The left spermatic vein has a valve at the entrance into the left renal vein to prevent blood backflow, and if the valve is absent or poorly developed, it can lead to varicose veins in the left spermatic cord. ③The upright posture of a person can affect the reflux of the spermatic veins. 3.What are the common manifestations of varicocele? Persistent or intermittent swelling sensation, vague or dull pain in the scrotum or testicles, often radiating to the perineum and groin on the same side. It is obvious after prolonged standing or prolonged walking, and relieves after lying down or resting. Patients with severe symptoms may have headache, fatigue, neuropsychiatric symptoms and sexual dysfunction. The affected scrotum and testicles are lower than the healthy side when the patient is standing, and in severe cases, earthworm-like varicose veins are visible and palpable. The Valsalva test can help determine the presence of varicose veins by holding the patient’s breath while standing to increase abdominal pressure, which can block blood return and help detect veins that are not obviously varicose. Varicocele can be classified into three degrees depending on the severity. Degree I: The varicose veins are not visible when standing, but only palpable. the varicose veins increase during the Valsalva test and disappear after lying down. Degree II: The varicose vein can be seen and touched when standing, and the varicose can be reduced or disappeared when lying down. Degree III: The varicose veins around the spermatic cord, epididymis and scrotum have obvious varicose veins, and the varicose disappears slowly or does not disappear after lying down. 4.Does varicocele cause male infertility? Varicocele accounts for 2% to 15% of the causes of male infertility. It is believed that varicocele can cause blood stasis in the veins, resulting in increased local temperature, CO2 accumulation in testicular tissues, and increased levels of cortisol, catecholamines, 5-hydroxytryptamine, prostaglandins, etc., thus affecting the blood supply to the testes and normal spermatogenic function, and causing male infertility. 5.How can varicocele be treated? The effective treatment for varicocele is surgery (high level ligation of spermatic veins). However, not every patient needs surgery. For those who have no obvious symptoms and signs, no fertility requirements or normal sperm quality, they may not be treated. Surgical treatment may be considered in the following cases: (1) the patient is infertile, has abnormal semen quality, normal endocrine tests, and the female partner has normal fertility or is infertile but may be cured. ②Patients who are temporarily infertile but have abnormal semen quality on examination. ③Those who have heavy related symptoms and signs, which affect the quality of life and do not improve significantly with conservative treatment. In addition, we should also be alert to the presence of secondary varicocele caused by primary diseases such as tumor compression in the spermatic cord vein travel area. At present, our department mainly carries out traditional transinguinal spermatic vein ligation and laparoscopic spermatic vein ligation.