Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents for evaluation of primary/secondary infertility. Semen analysis confirms azoospermia. History is significant for [e.g., prior vasectomy, inguinal hernia repair, or recurrent epididymitis]. Patient denies systemic illness, fever, or recent heat exposure. No history of mumps orchitis or chemotherapy. Sexual function is preserved with normal libido and erectile function.
Clinical Examination Findings
Physical examination reveals normal secondary sexual characteristics. Testicular volume is [e.g., 15-20 mL] bilaterally, with firm consistency. Epididymides are [e.g., indurated, enlarged, or tender]. Vas deferens are [e.g., palpable/absent bilaterally]. No evidence of varicocele or inguinal hernia. Digital rectal exam (DRE) is unremarkable; no midline prostatic cysts suggestive of ejaculatory duct obstruction.
Treatment Protocol
Recommended management: 1. Serum FSH, LH, and Testosterone levels to confirm normal spermatogenesis. 2. Genetic testing (CFTR mutation, karyotype) if indicated. 3. Surgical options: Microsurgical Vasovasostomy (VV) or Vasoepididymostomy (VE) for reconstruction. 4. Alternative: Sperm retrieval (PESA/TESE) for IVF-ICSI. 5. Referral to reproductive endocrinology for partner evaluation.