title: Assessment of testicular perfusion prior to sperm extraction predicts success rate and decreases the number of required biopsies in patients with non-obstructive azoospermia.
abstract: OBJECTIVE
  To assess the role of power and color Doppler ultrasonography (US) in patients with azoospermia prior to testicular sperm extraction.
  
  
  METHODS
  One hundred and thirty consecutive patients with azoospermia were assessed in this prospective study. Based on a semiquantitative method, the results of power Doppler US were graded into three categories: grade 1, no visible vessels; grade 2, between one and three detectable vessels; grade 3, more than three detectable vessels. The location of each visible vessel was also recorded as upper, middle or lower third of the testis.
  
  
  RESULTS
  Seventy-four patients with non-obstructive azoospermia (NOA) and 27 with obstructive azoospermia (OA) fulfilled the study criteria. OA patients revealed a significantly higher intratesticular perfusion compared with NOA patients. NOA patients with higher intratesticular perfusion required fewer biopsies for successful sperm retrieval. Moreover, a correlation was noted between the presence of visible vessels in each segment and the probability of successful sperm retrieval during biopsy from the corresponding segment.
  
  
  CONCLUSIONS
  Our data indicate that a semiquantitative, simplified power Doppler US assessment is capable of localizing areas containing viable sperm with the potential to direct biopsies to specific sites and subsequent decrease in the number of required biopsies.
authors.affiliation: Department of Urology, Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran, mrnowroozi@tums.ac.ir.
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Nowroozi
authors.forename: Mohsen
authors.initials: M
authors.lastname: Ayati
authors.forename: Erfan
authors.initials: E
authors.lastname: Amini
authors.forename: Kayvan
authors.initials: K
authors.lastname: Radkhah
authors.forename: Hassan
authors.initials: H
authors.lastname: Jamshidian
authors.forename: Asieh
authors.initials: A
authors.lastname: Delpazir
authors.forename: Faeze
authors.initials: F
authors.lastname: Ghasemi
authors.forename: Alireza
authors.initials: A
authors.lastname: Rajabzadeh Kanafi
mesh_terms: D000328:Adult; D053713:Azoospermia / Q000000981:diagnostic imaging* / Q000473:pathology; D044963:Biopsy, Fine-Needle; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D053625:Sperm Retrieval; D013737:Testis / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000473:pathology; D018615:Ultrasonography, Doppler, Color