Algorithm for the surgical management of obstructive azoospermia ‘Shaeerʼs algorithm’ and the prevalence of multiple-site obstruction

Shaeer, Kamal; Shaeer, Osama

doi:10.1097/01.xha.0000397013.21781.e9

Cited by 1 publication

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“…Alleviation of obstruction can be carried out using epididymovasostomy (EV), vasovasostomy, transurethral resection of the ejaculatory ducts or pelviscrotal vasovasostomy [4].…”

Section: Introductionmentioning

confidence: 99%

Sonographic epididymal dimensions as a predictor for epididymal sperm content in patients with obstructive azoospermia

Shaeer¹,

Shaeer²,

Elazizy³

et al. 2013

Human Andrology

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PurposeIn patients with obstructive azoospermia (OA), the decision for corrective surgery for resolving OA is in part based on the presence of sperms in the epididymis, which is suggested by palpation but is only confirmed upon surgical exploration. Similarly, percutaneous sperm aspiration from the epididymis for in-vitro fertilization is encouraged by a clinically full epididymis, which may prove inaccurate upon aspiration. Estimation of the epididymal sperm content is to-date reliant on palpation and is nonstandardized. This study aims at predicting the presence or absence of sperms in azoospermic patients suspected for obstruction using scrotal ultrasonographic measurements.Patients and methods A prospective study was performed comprising 30 OA patients, 20 nonobstructive azoospermic (NOA) patients, and 20 fertile men. Ultrasonographic dimensions of the epididymis and testis were compared in the study groups, as well as between the sperm-positive and sperm-negative patients upon epididymal sperm aspiration in the OA group. ResultsOA patients demonstrated a statistically significant increase over NOA patients in all sonographic parameters. Compared with controls, the OA patients demonstrated no statistically significant differences in testicular volume and length but showed statistically significant higher epididymal measurements. With the exception of total testicular volume and epididymal length, all other measurements showed a statistically significant increase in OA patients positive for epididymal sperm, compared with those negative for epididymal sperm, with the total epididymal volume and head volume being most pronounced, with a cutoff epididymal volume of 7 cm 3 , demonstrating a sensitivity of 92% and specificity of 91.7%. Conclusion Scrotal ultrasonography, particularly total epididymal volume, can serve as a predictor for the presence of sperms in the epididymis of patients with OA, aiding in case selection for corrective surgery or epididymal sperm retrieval.

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“…Alleviation of obstruction can be carried out using epididymovasostomy (EV), vasovasostomy, transurethral resection of the ejaculatory ducts or pelviscrotal vasovasostomy [4].…”

Section: Introductionmentioning

confidence: 99%