Testicular biopsy in patients with obstructive azoospermia

The present report studies the testicular biopsy lesions (histologic and se miquantitative) in a series of 48 patients with obstructive azoospermia of known etiology (vasectomy, congenital absence of vas deferens, herniorrhaph y, hydrocelectomy, Young's syndrome, and ejaculatory duct obstruction) in o rder to establish objective testicular data that permit the pathologist to diagnose an obstructive process, which should not be mistaken with a primar y testicular lesion. The semiquantitative study included determinations of the average numbers of spermatogonia, primary spermatocytes, young spermati ds (Sa + Sb), and differentiated spermatids (Se + Sd). According to this st udy, the testes were classified into the: following groups: (1) normal test es whose germ cell numbers were within normal limits (27 testes); (2) teste s with lesions in the adluminal compartment: these lesions comprise two sub groups: (2a) late sloughing of primary spermatocytes (both spermatid ty,es were greatly reduced in number while the other germ cell types were in norm al numbers) (45 testes); and (2b) early sloughing of primary spermatocytes (normal spermatogonial number, reduced number of spermatocytes, and scanty spermatids) (9 testes) ; and (3) lesions in the basal compartment: these le sions comprise two subgroups: (3a) pure hypospermatogenesis (a proportionat e decrease in the numbers of all germ cell types) (8 testes); and (3b) hypo spermatogenesis associated with sloughing of primary spermatocytes (decreas ed numbers of all germ cell types with a very scanty number spermatids) (4 testes). Two testes appeared hyalinized and one testis was removed owing to cryptorchidism. The most frequent testicular lesion observed (alteration i n che adluminal compartment of seminiferous tubules) seems to be related to the increase in hydrostatic pressure in the tight compartment formed by se miniferous tubules, rete testis, efferent ducts, the epididymal duct, and t he initial portion of the vas deferens. The severity of the lesions is prob ably related to the cause and span of the obstruction. Ln addition, two azo ospermic men without obstructive azoospermia and whose testicular biopsy st udy revealed meiotic anomalies (with the subsequent bad prognosis) were als o studied for comparison. The semiquantitative study of these patients perm itted the differential diagnosis between two lesion types. Testes with meio tic anomalies had a disproportionately elevated number of primary spermatoc ytes, and an extremely low number of young spermatids.