# The Diagnostic Value of Point-of-Care Ultrasonography in the Differential Diagnosis of Azoospermia: Introducing a Concept

## TL;DR

This study shows that point-of-care ultrasonography can reliably help diagnose the cause of azoospermia, guiding appropriate treatment decisions.

## Contribution

The study introduces a novel concept of using non-radiologist-performed scrotal POCUS for differential diagnosis of azoospermia.

## Key findings

- Scrotal POCUS had 100% sensitivity and 96.8% specificity in diagnosing obstructive azoospermia.
- All patients with no secondary obstruction signs on POCUS confirmed non-obstructive azoospermia.
- POCUS-guided procedures led to accurate diagnosis and appropriate treatment selection.

## Abstract

Purpose: The aim of this study was to investigate the effectiveness and reliability of point-of-care ultrasonography (POCUS) in the differential diagnosis of azoospermia. Materials and methods: Records of 175 patients who had previously been diagnosed with normal-volume, normal-PH azoospermia and who had undergone surgical sperm retrieval were reviewed retrospectively. Patients’ preoperative evaluations included a comprehensive history and physical examination and a routine scrotal POCUS performed during their initial consultation by a non-radiologist treating andrologist in a clinic setting. Positive scrotal imaging revealed ectasia of the rete testis and/or dilation of the epididymal ductules. Based on their preoperative assessments, patients were guided to undergo either testicular sperm aspiration (TESA)/microsurgical sperm aspiration (MESA) procedures for those with suspected obstructive azoospermia (OA) or microdissection testicular sperm extraction (micro-TESE) for those with suspected non-obstructive azoospermia (NOA). Results: Of the 175 patients, 58 patients had normal follicle-stimulating hormone (FSH) levels (≤12 IU/L) and normal testicular volume. Thirty of them had no secondary signs of obstruction in their scrotal POCUS and subsequently underwent micro-TESE. All were confirmed to have NOA. Twenty-eight patients demonstrated at least two secondary signs of obstruction on scrotal POCUS. Of these, 15 underwent TESA, and 13 underwent MESA procedures. Twenty-seven patients were confirmed to have OA, and one was confirmed as having NOA. Among this cohort of men, the sensitivity of scrotal POCUS in diagnosing OA was 100%, whereas the specificity was 96.8%. Positive and negative predictive values (PPVs and NPVs) were 96.4 and 100%, respectively. Conclusions: Scrotal POCUS is an effective clinical diagnostic tool for distinguishing obstructive and non-obstructive azoospermia. Being noninvasive, safe, and affordable makes it an ideal bedside clinical tool that can serve the skilled non-radiologist clinician reliably.