Imaging methods for seminal tract obstruction

Shatylko, T. V.; Гамидов, С. И.; Наумов, Н. П.; Al’ravashdekh, A.; Popova, Alina; Сафиуллин, Р. И.

doi:10.17650/1726-9784-2022-23-1-13-20

Cited by 2 publications

(1 citation statement)

References 29 publications

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“…On the contrary, OA has distinct etiology in most cases, being congenital or acquired [ 10 ] . Imaging studies may reveal the exact site of obstruction, which may influence further clinical decision‐making [ 11 ] .…”

Section: Introductionmentioning

confidence: 99%

Challenges in differential diagnosis between obstructive and non‐obstructive azoospermia

Gamidov,

Shatylko,

Tambiev

et al. 2024

UroPrecision

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BackgroundSome cases of non‐obstructive azoospermia (NOA) are characterized by normal clinical parameters, including testicular volume and levels of reproductive hormones, mimicking obstructive azoospermia (OA).MethodsWe performed a retrospective review of a consecutive series of 1417 patients undergoing primary surgical sperm retrieval between 2014 and 2023. Follicle‐stimulating hormone (FSH) level below 7.6 IU/l and normal testicular size with a long axis measurement >4.6 cm were used as criteria to suspect OA.ResultsFour hundred and eighteen patients with normal testicular volume and FSH levels had an initial diagnosis of OA. Among them, 243 (58.1%) had histological signs of spermatogenic dysfunction, and 175 (41.9%) had true OA. One hundred eleven patients had long‐standing obstruction (median: 16.5 years) with a median Bergmann–Kliesch score (BKS) of 5 (interquartile range [IQR]: 4–6) and 100% sperm retrieval rate (SRR), though some required microdissection testicular sperm extraction (microTESE). Fifty‐eight patients with a history of epididymo‐orchitis had a median BKS of 4 (IQR: 2–6) and 100% SRR. Twenty patients with a history of unjustified medical treatment for male infertility had a median BKS of 3 (IQR: 1–4) and 80% SRR. Fifty‐four patients had uniform maturation arrest with a 5.5% SRR on microTESE.ConclusionMen with normal testicular volume and FSH level may have evidence of spermatogenic failure on pathology. Patients with complicated seminal tract obstruction commonly have hypospermatogenesis, but true NOA caused by uniform maturation arrest may also be observed. Patient counseling for suspected OA should not be overly optimistic, and couples should be warned about possibility of conversion to microTESE and risks of negative sperm retrieval.

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Section: Introductionmentioning

confidence: 99%

Challenges in differential diagnosis between obstructive and non‐obstructive azoospermia

Gamidov,

Shatylko,

Tambiev

et al. 2024

UroPrecision

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Difficulties in differential diagnosis between obstructive and non-obstructive azoospermia

et al. 2022

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Introduction. The difference between obstructive and non-obstructive azoospermia (OA and NOA) is important for the choice of treatment tactics and adequate counseling of a married couple.Objective. To describe, analyze, and classify possible challenges in differentiating between two types of azoospermiaMaterials and methods. The retrospective review of database on surgical sperm retrieval attempts performed our hospital (n = 754). A subpopulation of 216 patients who were preliminary diagnosed with OA, was selected for further analysis. All patients had testicular pathology data following sperm retrieval attempt. Rate of reclassification was assessed as a primary outcome. Reclassified cases were further analyzed to find a possible reason for incorrect differential diagnosis.Results. Among 216 patients with initially suspected OA, 131 (60.6%) had evidence of spermatogenic dysfunction on pathological examination of seminiferous tubules. Multivariate regression analysis showed that only regular exposure to high temperatures was an independent predictor of NOA detection in patients with normal endocrine and clinical parameters (OR = 1.989; 95% CI = 1.101 – 3.595). Analysis of the decision tree showed that patients with inhibin B levels below 93 pg/ml had the highest risk of an incorrect initial diagnosis (82.6%).Conclusions. Differential diagnosis of OA and NOA is not such a simple task. Any case of azoospermia against the background of normal semen volume by default should be considered as a case of NOA if there is no anamnestic or clinical data clearly indicating obstruction. Regular exposure to high temperature is likely to cause azoospermia in men with initially severe disorders of spermatogenesis. Finally, the reference values of inhibin B offered by most laboratories are not intended to assess reproductive function.

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Imaging methods for seminal tract obstruction

Cited by 2 publications

References 29 publications

Challenges in differential diagnosis between obstructive and non‐obstructive azoospermia

Challenges in differential diagnosis between obstructive and non‐obstructive azoospermia

Difficulties in differential diagnosis between obstructive and non-obstructive azoospermia

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