Role of testicular fine-needle aspiration cytology in infertile men with clinically obstructive azoospermia.
BACKGROUND
Azoospermia due to obstruction of the vaso-epididymal junction is one of the few surgically correctable causes of male infertility. In patients where all clinical and laboratory parameters suggest a vaso-epididymal junction block amenable to surgery, failure to find normal spermatogenesis on fine-needle aspiration cytology (FNAC) of the testis may necessitate a change in treatment modality to the more expensive intracytoplasmic sperm injection. We evaluated the validity of FNAC findings in predicting failure of surgical exploration when clinical parameters suggest otherwise.


METHODS
Infertile, azoospermic men in whom the semen volume and fructose content, testis size, follicle-stimulating hormone level were normal and the vas deferens was palpable with no evident cause for obstruction, underwent FNAC of the testis to confirm the presence of normal spermatogenesis before surgical exploration. Men with hypospermatogenesis or maturation arrest on FNAC and a normal karyotype with absence of Y chromosome microdeletion were offered assisted reproduction or surgical exploration to identify a reconstructable obstruction. Men who chose surgery were included in the study and the findings on exploration were compared with the FNAC reports.


RESULTS
Of the 10 men who satisfied the inclusion criteria, 6 had hypospermatogenesis and in 4 FNAC showed maturation arrest. On surgical exploration, none had sperm in the epididymis. A biopsy of the testis taken at the time of exploration confirmed the FNAC findings.


CONCLUSIONS
Clinical parameters are insufficient for diagnosing obstructive azoospermia. FNAC can accurately evaluate the testicular pathology and predict whether or not surgical exploration should be undertaken.
Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. rajeev02@gmail.com
Rajeev
R
Kumar
Gagan
G
Gautam
N P
NP
Gupta
Manju
M
Aron
Rima
R
Dada
Kiran
K
Kucheria
Satish Kumar
SK
Gupta
Anurag
A
Mitra
D000293:Adolescent; D000328:Adult; D044963:Biopsy, Fine-Needle; D004543:Ejaculatory Ducts / Q000473:pathology; D004822:Epididymis / Q000473:pathology; D006801:Humans; D007248:Infertility, Male / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D009845:Oligospermia / Q000175:diagnosis / Q000473:pathology; D013737:Testis / Q000473:pathology*