Azoospermia is determined when no spermatozoa can be detected on high-powered microscopic examination of a pellet after centrifugation of the seminal fluid. A physician can initially identify the causes of azoospermia by an exhausted history and a complete physical examination. Men with testicular or pretesticular azoospermia should be offered genetic testing and measurement of serum sex hormones to exclude genetic abnormalities or hypogonadism. And the CFTR mutation test should be recommended to exclude the possibility of CF present in the offspring when azoospermia is related to CBAVD or primary epididymal obstruction. Testicular size, inhibin B levels and serum FSH concentration help to evaluate spermatogenesis of the testis, and diagnostic testicular biopsy can further distinguish obstructive causes from testicular failure in case of normal-sized testes. Vasography may be used to identify the site of obstruction, but only when reconstructive surgery is performed.
Azoospermia ; diagnosis ; etiology ; Humans ; Male ; Testis ; pathology

Animals ; Hepatocytes ; Ketoconazole/pharmacology* ; Liver/pathology* ; Male ; Mice ; Testis/pathology*

PURPOSE: Although retractile testes are frequently found in the pediatric population, there are controversies in the management of retractile testes. We investigated the necessity of treatment for retractile testes by analyzing their histologic findings. MATERIALS AND METHODS: Sixty-one testicular biopsies were performed during orchiopexy from 36 boys(range: 1.3-12.9 years, mean: 5.4 years) with retractile testes(11 unilateral, 50 bilateral) and 115 testicular biopsies from 83 cryptorchid patients(range: 0.6-15.0 years, mean: 3.7 years, 51 unilateral, 64 bilateral). Parameters for both Sertoli cell and germ cell were determined in each group. RESULTS: The average tubular degeneration phase(TDP) V-VII were 0.23+/-0.18 for retractile testes and 0.22+/-0.17 for cryptorchid testes and were not statistically different. Both the average sertoli cell index(SCI) and mean spermatogonia per tubules(S/T) value were statistically different between retractile and cryptrochid testes with values of 26.81+/-6.75, 23.04+/-5.85(p<0.01) and 2.96+/-1.33, 0.61+/-0.87(p<0.01), respectively. CONCLUSIONS: Although S/T value of retractile testes was higher than that of cryptorchid testes, Sertoli cell degenerative patterns were similar. These findings might indicate that retractile testis needs treatment like cryptorchid testis does. However, further investigation is warranted to elucidate whether these changes are normal variations since changes are observed in both Sertoli & germ cells in normal boys as they are aging.
Aging ; Biopsy ; Germ Cells ; Orchiopexy ; Pathology ; Spermatogonia ; Testis*

The testis is an immune privileged organ where germ cells are protected from autoimmune attack to ensure its reproductive function. Immune tolerance is important for the normal development and function of the testis. Notwithstanding its immune-privileged status, the imbalance between the tolerogenic and the efferent limb of the testicular immune response may lead to autoimmune damage in inflammatory or infected circumstances. Testicular immune regulation is a complex system involving multiple factors and the study of the regulation mechanisms of the testis is of great significance for access to new therapeutic targets. Currently, testicular immunoregulation is thought to be related with blood-testis barrier, Sertoli cells, immune cells, cytokines and androgen.
Humans ; Immune Tolerance ; Inflammation ; Male ; Testis ; immunology ; pathology

OBJECTIVETo determine the effects of cigarette smoking on the cyclogeny of spermatogenic cells in rats.

METHODSRat models of passive smoking were established using a self-made smoking device, and then allocated randomly into two passive smoking groups (A and B, n = 10) and two corresponding control groups (C and D, n = 10). Groups A and B were exposed to cigarette smoke for 8 weeks, followed by the sacrifice of the rats in Groups A and C. And the animals in Groups B and D were killed 48 days after the cessation of passive smoking. The spermatogenesis cycle of each group of rats was detected by flow cytometry, the levels of testosterone (T) and luteinizing hormone (LH) measured by radio-immunity method, and the testis histopathology analyzed by HE staining and transmission electron microscopy.

RESULTSCompared with Group C, Group A showed a significant decrease in the number of spermatids, spermatozoa ([18.76 +/- 3.58]%) and primary spermatocytes ([5.71 +/- 1.18]%) (P < 0.01), but an obvious increase in the spermatogonias ([55.98 +/- 5.35]%, P < 0.01), with a markedly decreased proliferation index ( P < 0.01). The rats of Group A also exhibited pycnosis of spermatocytes, nucleus aberration of Leydig cells, expansion and degranulation of the endoplasmic reticulum, decreased Golgi apparatus, increased lysosomes and fat drops of Sertoli cells, as well as a reduction in the thickness of the wall and the layers of seminiferous tubules and the number of spermatogonia. The T and LH levels were significantly lower in Group A than in C (P < 0.01). After the cessation of passive smoking, a remarkable increase was observed in the percentage of spermatozoa and primary spermatocytes and the levels of serum T and LH in Group B, although the latter were still lower than those of Group D.

CONCLUSIONSmoking damages spermatogenic epithelia, Leydig cells and Sertoli cells, reduces the T and LH levels, and block the proliferation of spermatogenetic cells. These changes can be partially reversed after cessation of smoking.

Animals ; Male ; Rats ; Rats, Wistar ; Smoking ; Spermatogenesis ; Testis ; pathology

OBJECTIVETo investigate the value and clinical application of the Three-Step Sperm Retrieval method in improving the sperm retrieval rate for non-obstructive azoospermia (NOA) patients.

METHODSSeventy-three NOA patients underwent Three-Step Sperm Retrieval in the following order of procedures: testicular fine needle aspiration (TFNA), testicular sperm extraction (TSE), and microdissection testicular sperm extraction (MD-TSE). The testicular tissue obtained from each step was observed for spermatozoa under the 400-fold inverted microscope. If spermatozoa were found in one step, the operation would be stopped; otherwise, the next step would be carried out. The testicular tissue was subjected to pathological examination.

RESULTSSpermatozoa was found in the testicular tissue in 38.4% of the cases (28/73) at TFNA as the first step, in 52.1% (38/73) at TFNA and TSE, and in 64.4% (47/73) at TFNA, TSE and MD-TSE. Pathological examination showed 25 of the cases to be Sertoli cell-only syndrome, 21 to be sperm maturation arrest and the other 27 to be hypospermatogenesis, in which spermatozoa were found in 10, 14 and 23 cases, respectively.

CONCLUSIONThe Three-Step Sperm Retrieval method can significantly improve the sperm retrieval rate for NOA patients. And the sperm retrieval rate is associated with the pathological type of the testicular tissue, a higher rate with hypospermatogenesis.

Adult ; Azoospermia ; Humans ; Male ; Sperm Retrieval ; Testis ; pathology ; surgery

OBJECTIVETo explore the management of the impalpable testis in children.

METHODSFrom April 2003 to August 2005, 36 children aged 20 months to 8 years with impalpable testes underwent inguinal and laparoscopy explorations. The clinical data were reviewed, including the indications of laparoscopy and inguinal explorations and the correspondence between the ultrasonic and surgical

RESULTSOf the 36 cases (36 / 361 ) of impalpable testis (41 testes), laparoscopy and inguinal explorations revealed 18 results. testes to be vanishing ones, 21 located intra-abdominally and 2 scrotal nubbins. Manifestations were divided into 4 types according to the laparoscopic findings, and 9 testes fell into Type I, 9 Type II, 13 Type III and 10 Type IV. Orchidopexies were performed by traditional and laparoscopic techniques. The positive diagnoses by ultrasound accounted for 75% (27/36). The volumes of the contralateral testes of the cryptorchid children were larger than those with intra-abdominal testes and testicular nubbins. One case of testicular atrophy was detected by ultrasound in the follow-up period.

CONCLUSIONLaparoscopy should be performed as a routine in children with impalpable testes. Children with Type II testes need not undergo inguinal exploration. Inguinal and scrotal explorations are necessary for children with Type I testes. Preoperative ultrasonic examination of the contralateral testis helps to evaluate vanishing testes or testicular nubbins.

Child ; Cryptorchidism ; diagnosis ; pathology ; surgery ; Follow-Up Studies ; Groin ; pathology ; Humans ; Male ; Testis ; pathology

OBJECTIVETo study the relationship between the testis volume and types of spermatogenic cells derived from testicular biopsy in patients with azoospermia or cryptozoospermia.

METHODSWe collected testicular pathological biopsies from 492 infertile patients with azoospermia or cryptozoospermia reported in our hospital, classified them according to the testicular histological classification methods in WHO Manual for Standardized Investigation, Diagnosis and Management of the Infertile Male, and analyzed the relationship of the testis volume with the results of semen analyses and testicular histology.

RESULTSOf the 492 cases, 90.5% (445/492) were azoospermia and 9.5% (47/492) cryptozoospermia; mature spermatozoa were present in the seminiferous tubules in 17.9% (88/492) but absent in 42.9% (211/492), and Sertoli cell-only syndrome indicated in 39.2% (193/492); the testis volume was < or = 10 ml in 38.6% (190/492) and < or = 5 ml in 7.9% (39/492). Cryptozoospermia was detected in 14.8% (13/88) of those with mature spermatozoa in the seminiferous tubules, in 11.4% (24/211) of those without, and in 5.2% (10/193) of those with Sertoli cell-only syndrome, with a significantly lower rate in the latter group than in the former two (P < 0.05).

CONCLUSIONSpermatogenesis of the testis may be focal and difficult to be completely reflected by a single testicular biopsy, and it may exist even if the testis volume is significantly below the reference value. The indications for testicular biopsy should not be improperly expanded. The WHO testicular histological classification methods have provided a convenient and effective guidance for further clinical examinations and establishment of a protocol.

Adult ; Azoospermia ; pathology ; Biopsy ; Humans ; Male ; Middle Aged ; Semen Analysis ; Spermatogenesis ; Spermatozoa ; pathology ; Testis ; pathology

Patients with non-obstructive azoospermia was once considered to be infertile due to impaired testicular spermatogenesis and consequent absence of sperm in the ejaculate. With the advent of intracytoplasmic sperm injection (ICSI), various testicular sperm retrieval techniques have been introduced recently, including fine needle aspiration, testicular sperm extraction, microdissection testicular sperm extraction, and so on. A large number of studies show that sperm can be retrieved in non-obstructive azoospermia patients, even in those with Klinefelter syndrome, because of the existence of isolated regions of spermatogenic tissue within the testis. 2010 EAU guidelines on male infertility recommend testicular sperm extraction or microdissection testicular sperm extraction for sperm retrieval from non-obstructive azoospermia. However, compared with testicular sperm extraction, the latter has a higher sperm retrieval rate with minimal postoperative complications. This article presents an overview on the prediction, operative procedure, sperm retrieval rate and postoperative complications of microdissection testicular sperm extraction.
Azoospermia ; pathology ; Humans ; Klinefelter Syndrome ; pathology ; Male ; Microdissection ; Sperm Retrieval ; Spermatozoa ; Testis ; pathology

Consensus ; Humans ; Male ; Neoplasms, Germ Cell and Embryonal/pathology* ; Specimen Handling ; Testicular Neoplasms/pathology* ; Testis/pathology*