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Urol Clin North Am. 2014 Feb;41(1):83-95. doi: 10.1016/j.ucl.2013.08.013. Epub 2013 Oct 15.

Obstructive azoospermia.

Author information

1
Center for Male Reproductive Medicine and Surgery, Department of Urology and Institute for Reproductive Medicine, Weill Cornell Medical College of Cornell University, 525 East 68th Street, Starr 9, New York, NY 10065, USA.

Abstract

Obstructive azoospermia accounts for 40% of azoospermia and results from obstruction of the excurrent ducts (due to many causes) at any location between the rete testis and the ejaculatory ducts. The diagnosis of obstructive azoospermia (OA) requires a stepwise approach to differentiate it from nonobstructive OA and to formulate management options. Localization of the site of obstruction relies on history, physical examination, and possibly laboratory, genetic, imaging tests, and intraoperative findings. The prospects for patients with OA are excellent given recent advances in microsurgical approaches and in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). Successful outcomes are increasingly likely after microsurgical reconstruction techniques, permitting non-IVF pregnancies for many couples. When reconstruction is not an option, microsurgical sperm retrieval provides excellent outcomes for patients in conjunction with IVF and ICSI.

KEYWORDS:

Ejaculatory duct obstruction; Epididymal obstruction; Microsurgical epididymal sperm aspiration; Obstructive azoospermia; Transurethral resection of ejaculatory ducts; Vasal obstruction; Vasoepididymostomy; Vasovasostomy

PMID:
24286769
DOI:
10.1016/j.ucl.2013.08.013
[Indexed for MEDLINE]
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