Asymptomatic male currently not desiring fertility with bilateral subclinical varicocele found on ultrasound evaluation and borderline semen analysis results

old (20–47 years old). Of notice, as a standard procedure, all patients were submitted to a careful physical examination including the external genitalia and palpation of the epididymis and testicles. Testicular volume was accessed using a Seager pachymeter and a Prader orchidometer. Any alteration in testis consistency, volume, or irregularity found in the initial examination was followed by a Doppler-stethoscope examination with the patient in the orthostatic position after 5 min standing at room temperature around 22–23°C. A positive reflux was considered using the Valsalva maneuver and continuous reflux auscultation (>2 s). Reasons for an initial appointment were routine andrological evaluation (9 patients), testicular pain (7 patients), varicocele found somewhere else in a checkup testicular color Doppler-ultrasound (6 patients), alleged complains related to hypogonadism (5 patients), after testicular self-examination alterations, investigation of delayed puberty and epididymitis (3 patients each), and premature ejaculation, low ejaculatory volume, evaluation of sexually transmitted diseases, nongonococcical urethritis, potential gonadotoxin exposure (2 patients each). Of notice, the three patients with past medical history of delayed puberty were diagnosed as pure Klinefelter Syndrome (2 patients) and one mosaicism (46, XY/47, XXY). Median right testicular volume was 18.3 ml and left testicle 16.9 ml. Excluding three Klinefelter patients, median sperm concentration was 38.22 million sperm ml −1 , total motility 60.2%, progressive motility 37%, and WHO normal morphology 26%. Creatine-kinase activity as an indicator of sperm quality and maturity measurement was 0.107 ± 0.086 IU 10 −8 sperm (normal <0.036 IU 10 −8 sperm). 5 Relatively small increase in CK activity in this group may be related to some degree of defect in spermiogenesis leading to inhibition of complete sperm maturation. 6 Of these 46 initial patients, 27 were followed up for over 5 years and although sperm concentration did not fell significantly, total motility showed a decrease of 44% as well as WHO normal morphology 21% and an increase in CK activity to 0.221 ± 0.116 IU 10 −8 sperm. To some degree, we can conclude that subclinical varicocele with long reflux has some effect on sperm maturation that may not significantly impair spermatogenesis. The routine use of color Doppler-ultrasound may increase the frequency or urological consultation for subclinical varicoceles, and the andrologist must be prepared to evaluate properly and propose a follow-up for these men. These findings, including diagnosis of potential medical conditions, in a routine urological evaluation, may raise the awareness of male reproductive health …