One hundred men with proven fertility who presented for vasectomy consultation were examined for testicular size and presence of a varicocele, including examination with the Doppler stethoscope for the presence of subclinical varicocele. A diagnosis of varicocele was established in 61%. In 17 patients, the varicocele was evident clinically, whereas in 44 patients it was subclinical (8 bilateral). There was a discrepancy in testicular size in 22 patients, but this group included 8 men without varicoceles and 7 with subclinical varicoceles. It is apparent that varicoceles, especially subclinical varicoceles, are an extremely common finding, even in a group of fertile men. The results suggest that subclinical varicoceles have no role in male infertility.
PIP: The incidence of subclinical and clinical varicocele, or reflux of blood into the internal spermatic vein, in the fertile population was estimated at 61% by examining 100 consecutive men who presented for vasectomy. The men averaged 36 years old (range 28-52), and 2.5 children, 67% of them having fathered a child less than 3 years old. Varicocele was determined by palpation, with a pencil probe held over the spermatic cord in the region of the pampiniform plexus, while the patient was standing and performing the Valsalva maneuver. The Doppler stethoscope was also used. A definite prolonged bruit was considered a positive, subclinical varicocele. A clinical left varicocele was seen in 17 men (17%), and a subclinical varicocele in 44 (44%); left in all but 1, and bilateral in 8 men. Reports in the literature range from 8-23% for clinically evident varicoceles. Apparently, subclinical varicocele has no detrimental effect on fertility.