The New "Board" Answer

From the AUA best practice guidelines:

"Testicular biopsy may be performed to
confirm the presence of reproductive tract obstruction in
patients with low ejaculate volume azoospermia and palpable
vasa. Transrectal ultrasonography, with or without
seminal vesicle aspiration and seminal vesiculography,
may be used to identify obstruction in the distal male
reproductive tract. Alternatively, vasography may be used
to identify the site of reproductive tract obstruction in
patients with low ejaculate volume azoospermia and palpable
vasa but should not be done unless reconstructive
surgery is undertaken at the same surgical procedure."

The new recommendation for low ejaculate volume in association with azoospermia (no sperm) is to proceed with seminal vesical aspiration rather than testis biopsy.

Seminal vesical is an in-office procedure and patients can have an answer minutes after the procedure.

Dr Schoor