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OBSTRUCTIVE AZOOSPERMIA

OBSTRUCTIVE AZOOSPERMIA

Obstructive azoospermia occurs due to congenital absence of the sperm ducts or due to occlusion of sperm channels as a result of infection, surgery or injury. It constitutes 40% of all azoospermia cases.

After diabetes mellitus, some diseases related to the nervous system or some cancer surgery operations, semen may not form at all. This condition is called "aspermia". Additionally, in these patients or in men with prostate surgery, the semen is thrown into the bladder, not come out. This situation is called "Retrograde Ejaculation = Backward Ejaculation". In these cases, there is also sperm production in testicle, but the ejaculation is no exit. These patients can also be considered in this group.

Obstructive azoospermia can be diagnosed easily with a detailed examination. In these men, testicular sizes are normal, testicles are compact and large. Sperm conduction channels are irregularly palpable or not palpable.

The generally accepted amount of ejaculate volume is less than 1.5 ml in obstructive azoospermic male. On the contrary, there is no ejaculate in cases of aspermia and retrograde ejaculation. To clarify the diagnosis in these patients, sperm search is made in the urine after masturbation. If sperm is detected in retrograde urine, this condition is considered as retrograde ejaculation. If there is no semen and sperm, it is considered as aspermia.

In the hormonal evaluation of the patients, FSH, LH, Total testosterone and Inhibin B levels associated with sperm production are normal. Rarely, Inhibin B level can be detected as slightly low.

Transrectal ultrasonography or pelvic MRI is applied to evaluate the sperm ducts in patients.

"Cystic Fibrous Gene Mutation = CFTR" is observed in 80% of cases with obstructive azoospermia. This gene also regulates the development of male sperm conduction channels. Therefore, CFTR gene mutation should be evaluated in patients with an absence of ducts.

In cases of obstructive azoospermia, there is no need for any drug treatment, since there is no sperm output. However, some drugs such as sympathomimetics can be used to normalize the ejaculate output in retrograde ejaculation and aspermia cases.

In these patients, sperm can be obtained by needle aspiration methods such as testicular sperm aspiration (TESA) or epididymal sperm aspiration (PESA) under local anesthesia. In some cases, surgical operations such as TUR-ED, vasovasostomy, vasoepididymostomy can be successfully applied.

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