Testicular histology based on testicular biopsy is an important factor for determining appropriate testicular sperm extraction surgery and predicting sperm retrieval outcomes in patients with azoospermia. Therefore, we developed a deep learning (DL) model to establish the associations between testicular grayscale ultrasound images and testicular histology. We retrospectively included two-dimensional testicular grayscale ultrasound from patients with azoospermia (353 men with 4357 images between July 2017 and December 2021 in The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China) to develop a DL model. We obtained testicular histology during conventional testicular sperm extraction. Our DL model was trained based on ultrasound images or fusion data (ultrasound images fused with the corresponding testicular volume) to distinguish spermatozoa presence in pathology (SPP) and spermatozoa absence in pathology (SAP) and to classify maturation arrest (MA) and Sertoli cell-only syndrome (SCOS) in patients with SAP. Areas under the receiver operating characteristic curve (AUCs), accuracy, sensitivity, and specificity were used to analyze model performance. DL based on images achieved an AUC of 0.922 (95% confidence interval [CI]: 0.908-0.935), a sensitivity of 80.9%, a specificity of 84.6%, and an accuracy of 83.5% in predicting SPP (including normal spermatogenesis and hypospermatogenesis) and SAP (including MA and SCOS). In the identification of SCOS and MA, DL on fusion data yielded better diagnostic performance with an AUC of 0.979 (95% CI: 0.969-0.989), a sensitivity of 89.7%, a specificity of 97.1%, and an accuracy of 92.1%. Our study provides a noninvasive method to predict testicular histology for patients with azoospermia, which would avoid unnecessary testicular biopsy.
Humans ; Male ; Azoospermia/diagnostic imaging* ; Deep Learning ; Testis/pathology* ; Retrospective Studies ; Adult ; Ultrasonography/methods* ; Sperm Retrieval ; Sertoli Cell-Only Syndrome/diagnostic imaging*

Objective: To compare three different pathways for transurethral seminal vesiculoscopy (SVS) and investigate the reliability and efficiency of transrectal ultrasonography (TRUS)-guided SVS (TRUS-SVS). METHODS: We retrospectively analyzed 90 cases of seminal vesiculoscopy conducted directly through the ejaculatory duct or prostatic utricle or under the guide of TRUS. We compared the success rate and complications among the three approaches. RESULTS: Operations were successfully performed in 87 (96.67%) of the 90 cases, 30 through the ejaculatory duct, 37 via the prostatic utricle, and 20 under the guide of TRUS, the operation time ranging from 25 to 75 minutes. Sperm was detected from the seminal vesicle fluid in (92.06%) of the azoospermia patients (58/63) during the surgery and in 77.78% of them (49/63) in semen analysis at 1 week postoperatively. Fifteen hematospermia and 12 spermatocystitis patients were cured. Postoperative follow-up found 20 cases of water-like semen and 3 cases of orchiepididymitis, but no such complications as retrograde ejaculation, incontinence, or rectourethral fistula. CONCLUSIONS Transejaculatory duct and transprostatic utricle pathways are two common approaches to SVS, while TRUS-SVS may achieve a higher success rate and avoid injury of both the prostate and the rectum.
Azoospermia ; diagnostic imaging ; Ejaculatory Ducts ; diagnostic imaging ; Epididymitis ; diagnostic imaging ; Genital Diseases, Male ; Hemospermia ; diagnostic imaging ; Humans ; Male ; Operative Time ; Prostate ; diagnostic imaging ; Rectum ; Reproducibility of Results ; Retrospective Studies ; Semen ; Semen Analysis ; Seminal Vesicles ; diagnostic imaging ; Spermatozoa ; Ultrasonography ; methods ; statistics & numerical data

ObjectiveTo summarize the experience in the diagnosis and treatment of refractory hematospermia and ejaculatory duct obstruction by seminal vesiculoscopy.

METHODSWe retrospectively analyzed the clinical data about 42 cases of refractory hematospermia and 6 cases of ejaculatory duct obstruction with azoospermia. We investigated the diagnosis, treatment, and prognosis of the diseases.

RESULTSAll the patients underwent pelvic MRI and seminal vesiculoscopy. MRI for the 42 refractory hematospermia patients showed that 21 (50.0%) had cystic dilatation in the uni- or bilateral seminal vesicles, 25 (59.5%) had abnormal internal signal intensity in the uni- or bilateral seminal vesicles, 12 (28.6%) had both the problems above, and 4 (9.52%) had no obvious abnormality in the seminal vesicle area. The bilateral seminal vesicles were <1 cm in width in 3 of the 6 cases of ejaculatory duct obstruction, and obviously enlarged in the other 3, but without abnormal internal signals. No recurrence was found during the 3－36 months follow-up.

CONCLUSIONSThe history and physical examination play important roles in the diagnosis of refractory hemospermia, and MRI is more valuable than TRUS in the diagnosis of seminal vesicle diseases. Seminal vesiculoscopy is an effective option for the management of persistent hematospermia and ejaculatory duct obstruction.

Azoospermia ; Ejaculatory Ducts ; diagnostic imaging ; physiopathology ; Endoscopy ; methods ; Hemospermia ; diagnostic imaging ; Humans ; Magnetic Resonance Imaging ; Male ; Recurrence ; Retrospective Studies ; Seminal Vesicles ; diagnostic imaging ; physiopathology

OBJECTIVETo explore the prediction of the site for microsurgical vasoepididymostomy (VE) in the treatment of epididymal obstructive azoospermia (OA).

METHODSThis study involved 56 infertile men with confirmed OA whose obstruction was suspected to be in the epididymis. Based on their medical history and results of preoperative physical examination and ultrasonography, we predicted the sites for VE. We performed surgical scrotal exploration for the status of epididymal obstruction, conducted palpation and microscopic observation for the epididymal tubules to be anastomosed, and finally decided on the sites for VE by making sure of the presence of motile sperm in the epididymal fluid of the patients. After surgery, we followed up the patients for the rate of pregnancy.

RESULTSAll the patients received bilateral scrotal ultrasonography and surgical scrotal exploration, totaling 112 procedures, including 98 VE procedures. The accuracy rate of the predicted sites for VE was 80.5% (153/190) by medical history and physical examination, 80.3% (90/112) based on the results of ultrasonography, and 87.4% (90/103) according to the first selected epididymal tubules. Of the 28 patients followed up for more than 12 months, motile sperm were found in 19 (67.9% ) at 2 to 12 months and spontaneous pregnancies were achieved in 10 (35.7%), all with the anastomotic sites in the corpus or cauda.

CONCLUSIONMedical history and physical examination contribute to the selection of anastomotic sites and non-invasive scrotal ultrasonography is effective and practical for positioning epididymal obstruction. The epididymal tubules with motile sperm for anastomosis could be easily obtained from the most dilated ones in indurated epididymides.

Azoospermia ; surgery ; Body Fluids ; Epididymis ; diagnostic imaging ; surgery ; Female ; Humans ; Male ; Microsurgery ; methods ; Pregnancy ; Pregnancy Rate ; Scrotum ; diagnostic imaging ; Ultrasonography ; Vas Deferens ; diagnostic imaging ; surgery

OBJECTIVETo evaluate the quantitative analysis by real-time elastosonography in the differential diagnosis of obstructive azoospermia (OA) and non-obstructive azoospermia (NOA).

METHODSWe evaluated the elastosonographic images of 200 cases of OA, 300 cases of NOA and 100 normal healthy controls, calculated the strain ratio of the testis to the scrotal skin and the median strain ratio among the three groups, and analyzed the best cut-off point for differentiating OA and NOA by the receiver operation characteristic (ROC) curve.

RESULTSThe median strain ratio of NOA was 0.49 +/- 0.43, while that of OA was 0.35 +/- 0.31, with significant difference between the two groups (Z = - 19.173, P = 0.000 < 0.017). According to the results of ROC curve analysis, the area under the curve was 0.857 +/- 0.012 and the best cut-off point for differentiating OA and NOA was 0.395 (sensitivity = 84.5%, specificity = 74.5%, accuracy = 80.5%).

CONCLUSIONQuantitative analysis by real-time elastosonography is a new valuable technique for the differential diagnosis of azoospermia.

Adult ; Azoospermia ; diagnostic imaging ; Case-Control Studies ; Diagnosis, Differential ; Humans ; Male ; Middle Aged ; Testis ; diagnostic imaging ; Ultrasonography ; methods ; Young Adult

OBJECTIVETo evaluate the application of scrotal ultrasonography in the diagnosis of the causes of azoospermia.

METHODSWe performed scrotal ultrasonography for 96 patients with azoospermia, and analyzed the ultrasonographic images in comparison with the results of the final diagnosis.

RESULTSBased on the characteristics of the ultrasonographic images, 35 of the cases were diagnosed as obstructive azoospermia and the other 61 as non-obstructive azoospermia, with an accuracy rate of 97.0%. The causes and sites of the lesions were manifested in 44.4% of the obstructive and 46.7% of the non-obstructive cases, with accuracy rates of 100% and 75.0%, respectively. As for the rest of the cases, scrotal ultrasonography helped narrow the scope of further examinations by giving directional indications.

CONCLUSIONScrotal ultrasonography is an essential means for the diagnosis of the causes of azoospermia, or for obtaining directional indications of its causes.

Adult ; Azoospermia ; diagnostic imaging ; Humans ; Male ; Scrotum ; diagnostic imaging ; Ultrasonography ; Young Adult

OBJECTIVETo assess the role of transrectal ultrasonography (TRUS) in the etiological diagnosis of male obstructive azoospermia.

METHODSWe retrospectively analyzed the clinical data and TRUS findings of 695 patients with obstructive azoospermia from January 2007 to May 2009.

RESULTSConcerning the etiology of obstructive azoospermia, the main TRUS findings included ejaculatory duct abnormality (29.2%), seminal vesicle abnormality (25.4%) and prostate midline cyst (18.5%). TRUS revealed 203 cases of ejaculatory duct dilation, 177 cases of seminal vesicle abnormality (including 108 with absence or agenesis and 51 with dilation of the seminal vesicle), and 128 cases of prostate midline cyst (including 75 with ejaculatory duct cyst and 39 with Müllerian cyst). Calcification of the verumontanum or ejaculatory duct was suspected to be the causes of obstructive azoospermia in 34 cases. However, no significant etiological abnormality was found in 153 cases. Obvious etiology was shown by TRUS in 78.0% of the patients.

CONCLUSIONTRUS can clearly display the structural abnormality of the ejaculatory duct and seminal vesicle, and provide important information on the etiology of male obstructive azoospermia.

Adult ; Azoospermia ; diagnostic imaging ; etiology ; Humans ; Male ; Middle Aged ; Rectum ; diagnostic imaging ; Retrospective Studies ; Ultrasonography

OBJECTIVETo investigate the ultrasonographic features of epididymides in congenital obstructive azoospermia (COA) and acquired obstructive azoospermia (AOA).

METHODSA total of 211 infertile men with obstructive azoospermia were observed by scrotal ultrasonography, and the features of the epididymal ultrasonograms were compared between COA and AOA.

RESULTSCOA exhibited significantly higher rates of ectasia in the epididymal head, cord-like changes, abrupt tapering and absence of the epididymal body and tail than AOA (P < 0.05), while AOA showed markedly higher rates of epididymal body and tail duct ectasia and epididymal inflammatory mass than COA (P < 0.01). Tubular ectasia of the epididymal duct in the head, body and tail were markedly higher in the COA (14 [5.9%], 41 [17.2%] and 20 [8.4%] cases in 236 epididymides) than in the AOA (P < 0.05). Retiform ectasia were markedly higher in the AOA (119 [64.0%], 142 [76.3%] and 109 [58.6%] cases in 186 epididymides) than in the COA (P < 0.05), with statistically significant differences between the two groups (P < 0.05). Ultrasonographically, the epididymides of the COA patients were characterized by irregular ectasia of the epididymal tube with decreased and unclear wall echoes (P < 0.05), and those of the AOA patients by regular ectasia with enhanced wall echoes (P < 0.01).

CONCLUSIONThe ultrasonographic epididymal features of COA are obviously different from those of AOA, which is of important clinical application value for distinguishing the two conditions from each other.

Adult ; Azoospermia ; congenital ; diagnostic imaging ; Epididymis ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Ultrasonography

OBJECTIVETo evaluate the diagnosis and surgical treatment of obstructive azoospermia.

METHODSWe analyzed the clinical data of 56 cases of obstructive azoospermia, 43 of them with ejaculatory duct obstruction (EDO), and the other 13 suspected of epididymal obstruction. The diagnostic methods included semen analyses, measurement of fructose and neutral alpha-glucosidase in the seminal plasma, transrectal ultrasonography (TRUS), and vasography when necessary. The 43 patients with EDO were treated by transurethral resection of the ejaculatory duct (TURED), and 11 of the 13 cases of suspected epididymal obstruction were confirmed by scrotal exploration and underwent either bilateral or unilateral vasoepididymostomy. The patients were followed up for 3 -51 months for postoperative semen quality and impregnation.

RESULTSOf the 43 azoospermia patients with EDO treated by TURED, 36 (83.7%) showed improved semen parameters and 11 (25.6%) achieved pregnancies. Among the 11 cases of azoospermia with confirmed epididymal obstruction treated by vasoepididymostomy, 6 (54.5%) had sperm in the semen assay and 3 (27.3%) achieved pregnancies.

CONCLUSIONSemen analyses, measurement of fructose and neutral alpha-glucosidase in the seminal plasma, TRUS and vasography are important diagnostic methods for obstructive azoospermia. TURED is effective for azoospermia with EDO, while vasoepididymostomy is preferable for the treatment of azoospermia with epididymal obstruction.

Adult ; Azoospermia ; etiology ; surgery ; Epididymis ; pathology ; surgery ; Humans ; Male ; Radiography ; Rectum ; diagnostic imaging ; Treatment Outcome ; Ultrasonography ; Vas Deferens ; diagnostic imaging ; surgery

OBJECTIVETo investigate the ultrasonographic features of obstructive azoospermia and to evaluate transrectal ultrasonography in the diagnosis of the disease.

METHODSWe performed transrectal ultrasonography for 248 patients with obstructive azoospermia, observed the sonographic features of the prostate gland, seminal vesicle and ejaculatory duct.

RESULTSThe average volume of the prostate gland of the studied group was 13.2 ml. A total of 111 cases showed normal sonographic features, 39 cases bilateral seminal vesicle defect, 33 cases bilateral seminal vesicle aplasia, 23 cases unilateral seminal vesicle defect and contralateral seminal vesicle aplasia, 28 cases bilateral and 14 cases unilateral seminal vesicle dilatation. Of the 42 cases of seminal vesicle dilatation, 18 had ejaculatory duct dilatation and 17 had cysts in the midline of the prostate.

CONCLUSIONObstructive azoospermia varies in kind. Transrectal ultrasonography can reveal the details of the prostate, seminal vesicle and ejaculatory duct and help to classify obstructive azoospermia and determine the location of the lesion.

Adult ; Azoospermia ; diagnostic imaging ; Ejaculatory Ducts ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Posture ; Prostate ; diagnostic imaging ; Rectum ; Seminal Vesicles ; diagnostic imaging ; Ultrasonography