Serial sonography and colour flow Doppler imaging following testicular and epididymal sperm extraction

Percutaneous epididymal sperm aspiration (PESA), percutaneous testicularsperm aspiration (TESA) and testicular sperm extraction (TESE) are invasiveprocedures and their consequences on the testis have not been clearlydefined. In order to relate the sonographic and colour Doppler flow changesto the clinical data, 14 patients with non- obstructive and six withobstructive azoospermia were examined by the same roentgenologistimmediately before, at 5 days, 2 weeks, 2 and 6 months after the surgicalprocedure. Testicular volumes remained unchanged during the follow-upperiod in both the non-obstructive and obstructive groups. Of thenon-obstructive group, focal testicular lesions were seen in 20 of the 26testes (77%) 5 days after the procedure and in 54% by 6 months. Ten werehypoechoic, of which six converted to echogenic foci, three remainedhypoechoic and one disappeared at 6 months. The other 10 were echogeniclesions, three of which were no longer visible at 6 months and theremainder were unchanged. In the obstructive azoospermic group, focallesions were not found. Extratesticular abnormality consistent withhaematoma was demonstrated in four non-obstructive cases, which disappearedat the 6 month examination, and in none of the obstructive azoospermicpatients. Whether residual focal lesions in the testes have long-termeffects remains to be evaluated. In the obstructive azoospermic group, theaspirations performed did not leave any sonographic abnormalities.