1. Which varicocele requires surgery? Classical indications: abnormalities in at least one semen parameter such as: viability, density, malformation rate, etc. Discomfort such as soreness and slight pain in the affected scrotum, if the pain is severe, it is usually not caused by seminal varicose. Whether varicocele requires surgery depends on whether the varicocele is clinical or subclinical, the presence or absence of symptoms, and semen parameters. Surgery is only considered if the varicocele is combined with discomfort in the affected scrotum and/or abnormalities in at least one semen parameter, and other etiologies are ruled out, and surgery is not advocated for subclinical varicocele. In adolescents with combined varicocele, the classic indication for surgery is that the development of the affected testis is compromised, but the specific assessment may vary from one surgeon to another and is inconsistent between Europe and the United States, so a careful outpatient evaluation is required. 2. Is varicocele always a cause of infertility or scrotal discomfort? Not necessarily, but if other common causes are excluded, 60-70% may be. 3, Is surgery always effective? The effectiveness rate is usually around 60-70%, and the pregnancy rate is only close to 70% two years after the surgery by world famous masters. This is often not because the surgery itself is unsuccessful, but sometimes varicocele is not the cause, and it is difficult to clarify if it is the cause before surgery. Likewise, the efficiency of surgery for scrotal discomfort symptoms is about the same. I usually introduce these to my patients before surgery, not to pass the buck, but because medicine has stages and limitations and is not a panacea, which is the state of medicine. We can proudly say that we offer the best technology at this stage, but not the almighty Dan technique. Many patients want their doctors to give a straightforward conclusion: to do or not to do? In my opinion, today, with a much higher degree of education for all, it makes the most sense to give patients the right to be fully informed, to fully understand the current state of medicine and its shortcomings, and to make a choice together. 4. Now that the new semen standards are very different from the fourth edition, which one should be used? The new standard and the old standard of semen parameters are used at the same time, and there were no semen parameters for Chinese people when the new standard was formulated, so there is no definite conclusion on which standard is used for Chinese people. It is generally recommended to make a comprehensive judgment in an outpatient clinic before deciding on a treatment plan. For patients who have never had a sexual partner or who have not tried to have a baby for more than 6 months, I usually put a stricter indication for the surgery, after all, abnormal semen parameters do not mean that the partner cannot get pregnant. 5. What is the procedure, the number of days of hospitalization, and the cost? Is it covered by medical insurance? We usually use microscopic surgery, the unilateral microscopic procedure takes about 30-45 minutes, the hospital stay is 3-5 days, and the total cost is about 6-8 thousand dollars. Some of them use laparoscopic procedure and the cost is about $9,000. However, in practice there are fluctuations between individuals and it is difficult for me to provide an absolute value. The issue of medical insurance varies from place to place in terms of policy, so I cannot answer, so you can consult your local medical insurance office. 6. Common complications? Recurrence, edema and testicular atrophy. However, the recurrence rate of our microsurgery is less than 2%, edema is very rare, and we have not seen any cases of testicular atrophy yet. 7. Will the tortuous and drooping scrotum disappear after surgery? The principle of the surgery is to block the venous reflux, not to remove the veins in the scrotum, which would easily lead to edema and testicular atrophy, so the scrotal tortuosity generally decreases gradually after the surgery and some of them can disappear, but not all patients have this effect. In the past, the surgery would usually suspend the levator muscle upward a bit, but it has been abandoned now, so the surgery no longer deliberately solves the problem of ptosis. 8.Will the quality of semen decrease after surgery? Is it possible that the symptoms of discomfort will worsen? Theoretically, yes, but it is very rare. It may be seen in two cases: (1) post-operative edema and atrophy, which are related to the surgery; (2) varicocele itself is not the cause, but the cause still exists, such as radiation, environmental hormones, other causes, etc. 9.Is there any other treatment for varicocele? What are the advantages and disadvantages? These include laparoscopic techniques, microscopic techniques (subepidural or transinguinal, we decide on the route depending on the height of the epidural ring, transinguinal is usually chosen if the epidural ring is too low), open techniques (subepidural, transinguinal, retroperitoneal routes), interventional techniques (cascade or retrograde approach), etc. Objectively, all of these modalities are used by physicians, and it is difficult to determine the absolute advantages and disadvantages. The surgical approach and results also depend on the experience of the operator, with more recent comparative studies supporting the microscopic technique in a few articles. As for treatments other than surgery: medication will be effective in some patients, and a small percentage of patients who do not receive any treatment can have a pregnancy, but overall studies show that surgery is better than medication and medication is better than no treatment. 10. Do both sides of the varicocele have to be done? If there is a problem with the quality of semen, we do both sides; if the patient is seen for symptoms, we do the symptomatic side; these refer to the clinical type of varicocele, the subclinical type of varicocele (no findings on physical examination, only reflux on ultrasound) does not advocate surgery, but there is controversy in this area. Are there any patients who request surgery and we refuse? Yes, some patients do not have clear indications for surgery (such as some infertility), and some patients with symptomatic complaints, whose degree obviously cannot be explained by varicocele alone, have a more obvious psychological color or anxiety, and some even say that I am “irresponsible” because of this, and one patient even grabbed me by the shirt and said: “I just want you to give One patient even grabbed my clothes and said: “I just want you to do the surgery for me, don’t worry about anything else! In fact, hospitals are places where people are treated and saved, so how can they be too busy for surgery? In fact, the hospital is a place to treat patients, which will be too many patients for surgery. Only, medicine has its own standards, I hope we understand and understand. I actually recommend surgery to no more than half of the patients who claim to have seminal curvature and come to me for surgery after careful evaluation. 12. Notes on semen examination Generally, abstinence for 3-7 days is clinically recommended, but I suggest that about 4-5 days is best. Patients who may need semen examination in outpatient clinics are advised to calculate their own abstinence time so that they will not be unable to be examined when they visit the clinic. (Masturbation, seminal emission and sexual ejaculation are all considered ejaculation.) 14. Regarding post-operative problems, it is generally possible to return to sexual life in one month, and strenuous activities such as running and ball games are recommended for two months after surgery. I really have difficulty answering the question of local pain and discomfort after surgery, because it can be related to the surgery, but also may be a new situation, arbitrarily say no problem may delay the disease, so I can not make a positive answer! I can only recommend that you go to a regular hospital for consultation! Some patients have multiple ejaculations, so there is no need to worry.