A preliminary report of "subclinical varicocele": diagnosis by Doppler ultrasonic stethoscope. Examination and initial results of surgical therapy.

Two hundred sixteen consecutive infertility patients were examined with the Doppler ultrasonic stethoscope to detect incompetence of the gonadal vein valves, the precursor of frank varicocele. All 75 men with clinically palpable varicoceles had positive Doppler findings. In 33 cases varicocele could not be definitely excluded because of unsatisfactory physical examinations; the Doppler findings were negative in 13, positive in 13 and equivocal in 7 of these men. Eighty-nine men had no evidence of varicocele on physical examination and negative Doppler findings. However, 19, patients with no palpable varicocele had positive Doppler examinations. With respect to testicular size and semen quality, this subclinical varicocele group could not be clearly distinguished from patients with idiopathic semen quality depression. Nevertheless, five men with subclinical varicocele and oligoasthenospermia underwent internal spermatic vein ligation. Postoperatively, four had negative Doppler examinations. Two patients showed a significant improvement in semen quality, and both men fathered children after several months. We believe that these preliminary results justify further investigation of "subclinical varicocele".