Diagnostic findings from testis fine needle aspiration mapping in obstructed and nonobstructed azoospermic men

Purpose: Although helpful for defining extratesticular obstruction, the tes tis biopsy offers limited information on nonobstructive azoospermic testes. Guided by diagnostic biopsies, testis sperm extraction procedures fail in 25% to 50% of patients with nonobstructive azoospermia, largely because it is clinically difficult to know where sperm are located. To provide a more complete assessment of spermatogenesis in nonobstructive azoospermic patien ts and to simplify the confirmation of sperm production in men with obstruc tion, we use a systematic, fine needle aspiration "mapping" procedure. We s ummarize the diagnostic findings in a series of azoospermic men. Materials and Methods: From 118 azoospermic infertile men (22 with obstruct ed and 96 with nonobstructed azoospermia) fine needle aspiration data were used to generate location specific, sperm frequency maps for obstructed and nonobstructive azoospermic testes to determine if "sperm rich" locations e xisted. Results: Fine needle aspiration map analysis revealed that all aspiration l ocations from obstructed cases showed sperm. In men with nonobstructive azo ospermia, sperm was identified in the right testis in 134 of 652 (20.5%) an d in the left testis in 151 of 716 (21.1%) separate aspirations. Rates of s perm detection among various intratesticular sites were not statistically d ifferent. In 27.1% of cases the fine needle aspiration map found sperm in m en with sperm negative biopsies. The likelihood of heterogeneity in fine ne edle aspiration sperm findings was 25% within individual nonobstructive azo ospermic testes and 19.2% between testis sides. At post-procedure followup of 88 patients (74%), no clinical or surgical complications were observed. Conclusions: Testis fine needle aspiration mapping is a simple, reliable an d informative diagnostic tool in the evaluation of azoospermic infertile me n.