Purpose: To evaluate power Doppler ultrasonography to predict sperm recovery in azoospermic patients. Methods: Color Doppler and power Doppler ultrasonography of testis were performed in 38 patients before testicular sperm extraction. Analysis of blood flow included the pulsatility and resistance index of intratesticular vessels and testicular artery, and power Doppler of testis. The results of power Doppler of testis were classified into three categories: 0, no vessels found; 1, one to three vessels; 2, more than three vessels found. Results: Power Doppler of both testis showed a significant difference between obstructive azoospermia and non-obstructive azoospermia (Fisher’s exact test – P = 0.02), and between the groups with and without sperm recovery (Fisher’s exact test – P = 0.001). Doppler indices of intratesticular vessels and testicular artery were similar between the groups. Conclusions: Testicular Power Doppler assessment showed that patients with obstructive azoospermia have better blood flow than patients with non-obstructive azoospermia, and power Doppler is able to predict sperm recovery in azoospermic patients.