Department of Urology, Naval Medical Center San Diego, San Diego, California; Department of Urology, Naval Medical Center Portsmouth (RCW), Portsmouth, Virginia.
Department of Urology, Naval Medical Center San Diego, San Diego, California; Department of Urology, Naval Medical Center Portsmouth (RCW), Portsmouth, Virginia.
J Urol. 2015 Apr;193(4):1318-21. doi: 10.1016/j.juro.2014.10.048. Epub 2014 Oct 16.
Male infertility is commonly seen at urology clinics and 10% to 20% of infertile males are found to be azoospermic. Azoospermia is classically categorized as nonobstructive or obstructive. This classification tailors the evaluation, diagnosis and proper treatment. We performed a retrospective study to provide an updated etiology of azoospermia in patients in the United States in a universal health care model.
We retrospectively reviewed the records of men with azoospermia who presented to our institution between 2004 and 2012. Laboratory data were analyzed, included semen analysis, follicle-stimulating hormone, luteinizing hormone, testosterone, semen fructose and genetic studies. Patients underwent scrotal exploration as indicated for testis biopsy and sperm extraction.
We reviewed 139 outpatient records. Nonobstructive azoospermia was diagnosed in 99 men (71%), including 33 (34%) identified with Sertoli-cell only syndrome. Other etiologies included an idiopathic cause in 25 cases (26%), Klinefelter syndrome in 9 (9%), maturation arrest in 9 (9%), Y chromosome microdeletion in 5 (5%), cryptorchidism in 4 (4%), trauma in 4 (4%), exogenous testosterone supplementation in 4 (4%) and other genetic disorders in 6 (6%). Obstructive azoospermia was identified in 40 men (29%), of whom 16 (40%) had congenital bilateral absence of the vas deferens. Other etiologies included an idiopathic cause in 11 cases (28%), an iatrogenic condition due to a surgical cause in 5 (13%), ejaculatory duct obstruction in 3 (8%), trauma in 1 (3%), retrograde ejaculation in 1 (3%), vas deferens occlusion in 2 (5%) and unilateral absence of the vas deferens in 1 (3%).
This study delineates the etiology of azoospermia in men with universal access to care.
男性不育症在泌尿科诊所中很常见，10%至 20%的不育男性被发现无精子症。无精子症经典地分为非梗阻性或梗阻性。这种分类适用于评估、诊断和适当的治疗。我们进行了一项回顾性研究，旨在提供在美国普遍医疗保健模式下男性无精子症患者的最新病因。
我们回顾性分析了 2004 年至 2012 年间我院就诊的无精子症男性患者的记录。分析了实验室数据，包括精液分析、卵泡刺激素、黄体生成素、睾酮、精液果糖和遗传研究。根据需要进行睾丸活检和精子提取的阴囊探查。
我们审查了 139 份门诊记录。诊断为非梗阻性无精子症 99 例（71%），其中 33 例（34%）为唯支持细胞综合征。其他病因包括特发性病因 25 例（26%）、克氏综合征 9 例（9%）、成熟阻滞 9 例（9%）、Y 染色体微缺失 5 例（5%）、隐睾 4 例（4%）、外伤 4 例（4%）、外源性睾酮补充 4 例（4%）和其他遗传疾病 6 例（6%）。诊断为梗阻性无精子症 40 例（29%），其中 16 例（40%）为先天性双侧输精管缺如。其他病因包括特发性病因 11 例（28%）、手术引起的医源性病因 5 例（13%）、射精管梗阻 3 例（8%）、外伤 1 例（3%）、逆行射精 1 例（3%）、输精管阻塞 2 例（5%）和单侧输精管缺如 1 例（3%）。
本研究描绘了在普遍获得医疗服务的情况下男性无精子症的病因。
