Markedly abnormal semen findings caused by urospermia: Diagnosis by pre-ejaculatory bladder emptying

We report a case of urospermia presenting as markedly abnormal semen findings. A 35-year-old man was referred for extremely large ejaculate volume (21.3 mL), markedly acidic semen pH (5.0), and only one sperm observed in the entire microscopic field. After the patient voided immediately before ejaculation, repeat semen analysis showed normalization of semen parameters, including an ejaculate volume of 5.2 mL, pH 7.5, and sperm concentration of 111 million/mL. This case highlights urospermia as an underrecognized cause of abnormal semen findings and demonstrates that simple bladder emptying before ejaculation can yield clinically valuable information.