Surgery for azoospermia in the Indian patient: Why is it different?

Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
Indian Journal of Urology 01/2011; 27(1):98-101. DOI: 10.4103/0970-1591.78441
Source: PubMed


Obstructive azoospermia is one of the few surgically correctable causes of male infertility. The outcomes of surgery in these patients are variable and often dependent upon the diagnosis and surgical expertise. We aimed to review the reported outcomes in Indian patients and evaluate potential reasons why these outcomes may be different from those reported from other regions. A search was performed on Medline/Pubmed using relevant keywords to identify publications from India on surgical management of azoospermia. The same search was repeated on Google and on the website of the Indian Journal of Urology. Personal emails were sent to prominent urologists performing surgery for azoospermia in India to obtain their opinions and reprints of their published articles. These were then reviewed. Very few articles were identified that pertained to the original search. A large majority of patients are diagnosed with idiopathic infertility. The outcomes of surgery where a clear diagnosis can be made are generally good and often comparable with the published literature. Infections are probably an under-diagnosed etiology. More research and publications are required to determine the etiology of obstructive azoospermia in the Indian men. These would help appropriate patient counseling and treatment.

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    ABSTRACT: Infertility may be the sole manifestation of genitourinary tuberculosis (TB) and men with idiopathic obstructive azoospermia are often screened for TB using semen polymerase chain reaction (PCR) test. We assessed the benefits of such screening. Totally, 100 infertile men with idiopathic obstructive azoospermia were screened with a kit-based PCR for semen TB. Confirmatory tests for TB were performed in PCR positive men before administering anti-tubercular therapy (ATT) for 6 months. Semen analysis was repeated to assess benefits of treatment. Seven subjects (7%) had positive semen PCR for TB. Four of them had other clinical evidence of TB (history and physical signs) and were administered ATT. None had any improvement in semen parameters. No subject had any other laboratory evidence of TB and no other subject (96%) was administered ATT. Screening for TB using semen PCR did not identify any men who would have been missed on clinical evaluation and is thus not indicated in men with idiopathic obstructive azoospermia.
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