Azoospermia: Indeterminate Etiology

  • John P. Mulhall
  • Peter J. Stahl
  • Doron S. Stember


In some cases it may be difficult to ­distinguish between obstructive and nonobstructive azoospermia based on the initial clinical evaluation. These indeterminate cases include patients with borderline clinical findings such as mild serum FSH elevations and mildly low testicular ­volumes, as well as patients in which discrepancies exist between the clinical history, physical examination, and serum hormone evaluation. The classic approach in these cases has been performance of diagnostic testicular biopsy for direct histologic assessment of spermatogenesis and remains the gold standard for diagnostic evaluation. However, most experts (including the authors) advocate directly proceeding to exploratory surgery without performance of a separate testicular biopsy. The advantage of this approach is that it is both diagnostic and therapeutic, allowing for management of the patient with indeterminate azoospermia with a single procedure.


Cystic Fibrosis Transmembrane Conductance Regulator Tunica Albuginea Testicular Biopsy Exploratory Surgery Sperm Retrieval 
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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • John P. Mulhall
    • 1
  • Peter J. Stahl
    • 2
  • Doron S. Stember
    • 3
  1. 1.Sexual and Reprodictive Medicine Program Department of Surgery Division of Urology, Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  2. 2.Department of UrologyColumbia University College of Physicians & SurgeonsNew YorkUSA
  3. 3.Department of UrologyBeth Israel Medical Center Albert Einstein College of Medicine of Yeshiva UniversityNew YorkUSA

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