DOPPLER ULTRASOUND OF THE TESTIS IN AZOOSPERMIC SUBJECTS AS A PARAMETER OF TESTICULAR FUNCTION

Azoospermia frequently represents the end-point of different pathologi cal conditions that cause important quantitative and qualitative alter ations of both spermatogenesis and testicular structure, including int ratesticular blood vessels. In this study we performed colour Doppler ultrasound of the testis in 12 azoospermic subjects affected by primar y testicular pathology (four bilateral post-orchitis, four post-radiot heraphy for cancer, four post-traumatic) aged 28.2 +/- 3.3 (mean +/- S D) Sears, in six subjects affected by obstructive azoospermia aged 29. 7 +/- 2.4 years and in 20 age-matched fertile subjects (aged 28.6 +/- 2.5 years). The analysis of intratesticular vessels per organ was quan tified using a semiquantitative score: category 0, no vessels visible; category 1, between one and three intratesticular vessels visible; an d category 2, more than three vessels visible. In obstructive azoosper mic patients and in fertile subjects there were always more than three intratesticular vessels. No intratesticular vessels were detected in eight testes (33.3%) and fewer than three vessels in 16 testes (66.6%) in subjects affected by primary testicular pathology. In azoospermic subjects the testicular structure of the testis was evaluated by diagn ostic fine needle aspiration cytology (FNAC) performed in the middle p ortion of the testis, In non-obstructive azoospermic patients this pro cedure showed the presence of only Sertoli cells in all cases. When de tectable vessels were present, a new aspiration was performed in these areas. In 12 out of 16 cases, spermatogenetic cells including mature spermatozoa, were found when the FNAC was performed in testicular regi ons showing the presence of blood vessels. These results indicate that colour Doppler sonography of the testis may be useful in the differen tial diagnosis of azoospermia and suggest the evaluation of the intrat esticular blood vessel distribution before performing any method to re trieve intratesticular spermatozoa for intracytoplasmic sperm injectio n.