Prediction of candidates for seminal tract reconstructive surgery among patients with clinically suspected idiopathic or inflammatory obstructive azoospermia.

Background and Aim:  We reviewed the findings of scrotal exploration, histological examination and clinical parameters in patients with clinically suspected idiopathic or inflammatory obstructive azoospermia without confirmation by isolated testis biopsy in advance.

Methods

The present study included 27 patients who underwent scrotal exploration for the purpose of vasoepididymostomy, with simultaneous testicular sperm extraction.

Results

Sperm in the epididymis was proven in 11 patients (40.7%). In two of these patients, the vas deferens was obstructed on the seminal vesicle side. Histologically, normal spermatogenesis was seen in all patients. The 16 (59.2%) patients with no sperm in the epididymis included two with normal spermatogenesis. Serum follicle stimulating hormone (FSH) levels were significantly higher in men with no sperm in the epididymis in contrast to those in men with sperm proven in the epididymis (P = 0.0057). By using a cut-off point of 6.02 mIU/mL, serum FSH can predict the existence of sperm in the epididymis, with a sensitivity of 81.8%, a specificity of 81.2% and a positive predictive value of 75.0%.

Conclusion

No more than a third of the patients in the present study who had clinically suspected obstructive azoospermia were actual candidates for vasoepidydimostomy. A serum FSH level cut-off point of 6.02 mIU/mL might be useful to determine its indication. (Reprod Med Biol 2006; 5: 211-214).