It is time to abandon "expected bladder capacity." Systematic review and new models for children's normal maximum voided volumes.

BACKGROUND: There is an agreement to use simple formulae (expected bladder capacity and other age based linear formulae) as bladder capacity benchmark. But real normal child's bladder capacity is unknown. AIMS: To offer a systematic review of children's normal bladder capacity, to measure children's normal maximum voided volumes (MVVs), to construct models of MVVs and to compare them with the usual formulae. METHODS: Computerized, manual and grey literature were reviewed until February 2013. Epidemiological, observational, transversal, multicenter study. A consecutive sample of healthy children aged 5-14 years, attending Primary Care centres with no urologic abnormality were selected. Participants filled-in a 3-day frequency-volume chart. Variables were MVVs: maximum of 24 hr, nocturnal, and daytime maximum voided volumes. FACTORS: diuresis and its daytime and nighttime fractions; body-measure data; and gender. The consecutive steps method was used in a multivariate regression model. RESULTS: Twelve articles accomplished systematic review's criteria. Five hundred and fourteen cases were analysed. Three models, one for each of the MVVs, were built. All of them were better adjusted to exponential equations. Diuresis (not age) was the most significant factor. There was poor agreement between MVVs and usual formulae. Nocturnal and daytime maximum voided volumes depend on several factors and are different. CONCLUSIONS: Nocturnal and daytime maximum voided volumes should be used with different meanings in clinical setting. Diuresis is the main factor for bladder capacity. This is the first model for benchmarking normal MVVs with diuresis as its main factor. Current formulae are not suitable for clinical use.

Large-cell neuroendocrine carcinoma of prostate. Case report.

OBJECTIVE: To report a case of a neuroendocrine differentiation in a prostate cancer patient, a rare subtype. METHODS: We describe the case of a patient diagnosed with adenocarcinoma of the prostate initially, who presented hematuria due to disease progression with neuroendocrine differentiation despite androgen-deprivation therapy (ADT ). DISCUSSION: Prostate cancer is the most common tumor in men. Histologically they are diagnosed as adenocarcinomas, which followed by ADT for a long time, develop neuroendocrine differentiation (NED ). CONCLUSIONS: The prognostic significance of NED remains controversial. We must think in neuroendocrine differentiation in ADT-treated patient with disease progression and low PSA.

Paratesticular rhabdomyosarcoma: a case report.

OBJECTIVE: To report a case of paratesticular rhadomyosarcoma and to perform a bibliographic review. METHODS: We report the case of a 16-year-old male referred to our Department because of a left paratesticular hard tumor with progressive growth. Ultrasound examination showed a paratesticular heterogeneous mass with Internal flow on Doppler. RESULTS: The patient underwent left inguinal orchiectomy, with pathological diagnosis of rhabdomyosarcoma. He refused adjuvant chemotherapy. After being disease-free for 13 months, he presented with left colic pain. Ultrasound and CT examinations showed a left paraaortic retroperitoneal mass causing grade III ureterohydronephrosis, and lung metastases. Despite rescue chemotherapy treatment, there was no response and the abdominal mass progressed. A surgical approach was not possible since patient showed a rapid clinical worsening leading to his death a few weeks later. CONCLUSIONS: Paratesticular sarcomas are very uncommon tumors with poor prognosis.

Carcinoma neuroendocrino de célula grande prostático. A propósito de un caso / Large-cell neuroendocrine carcinoma of prostate. Case report

OBJETIVO: Presentar un caso de cáncer de próstata con diferenciación neuroendocrina de célula grande, un subtipo muy infrecuente. MÉTODOS: Se describe el caso clínico de un paciente previamente diagnosticado de adenocarcinoma de próstata que debuta con hematuria como progresión de la enfermedad hacia diferenciación neuroendocrina a pesar del tratamiento hormonal. DISCUSIÓN: el cáncer de próstata es el tumor más frecuente diagnosticado en el varón. Histológicamente son diagnosticados de adenocarcinoma de próstata, que tras tratamiento hormonal durante largo tiempo desarrollan una diferenciación neuroendocrina (DNE). CONCLUSIONES: el significado pronóstico de la DNE sigue siendo controvertido. Debemos pensar en la diferenciación neuroendocrina ante un paciente en tratamiento con bloqueo hormonal, con progresión de la enfermedad, y PSA bajo (AU)

OBJECTIVE: To report a case of a neuroendocrine differentiation in a prostate cancer patient, a rare subtype. METHODS: We describe the case of a patient diagnosed with adenocarcinoma of the prostate initially, who presented hematuria due to disease progression with neuroendocrine differentiation despite androgen-deprivation therapy (ADT).DISCUSSION: Prostate cancer is the most common tumor in men. Histologically they are diagnosed as adenocarcinomas, which followed by ADT for a long time, develop neuroendocrine differentiation (NED). CONCLUSIONS: The prognostic significance of NED remains controversial. We must think in neuroendocrine differentiation in ADT-treated patient with disease progression and low PSA (AU)

Radomiosarcoma paratesticular: a propósito de un caso / Paratesticular phabdomyosarcoma: a case report

OBJETIVO: Presentar un caso de radomiosarcoma paratesticular y revisión de la literatura. MÉTODOS: Describimos el caso de un varón de 16 años remitido a nuestro servicio por masa paratesticular izquierda de crecimiento progresivo, con imagen ecográfica de tumoración paratesticular heterogénea con flujo Doppler en su interior. RESULTADOS: Se realizó orquiectomía izquierda, con diagnóstico de rabdomiosarcoma. El paciente rechazó el tratamiento quimioterápico adyuvante. Tras 13 meses libre de enfermedad, reingresó por dolor cólico izquierdo detectándose en ecografía y TC una masa retroperitoneal paraaórtica izquierda que condicionaba uréterohidronefrosis grado III, y metástasis pulmonares. A pesar de instaurarse quimioterapia de rescate, no respondió presentando rápida progresión de la masa abdominal con importante deterioro general que no permitió el abordaje quirúrgico, siendo éxitus a las pocas semanas. CONCLUSIÓN: Los sarcomas paratesticulares son tumores infrecuentes y de mal pronóstico(AU)

OBJECTIVE: To report a case of paratesticular rhadomyosarcoma and to perform a bibliographic review. METHODS: We report the case of a 16-year-old male referred to our Department because of a left paratesticular hard tumor with progressive growth. Ultrasound examination showed a paratesticular heterogeneous mass with Internal flow on Doppler. RESULTS: The patient underwent left inguinal orchiectomy, with pathological diagnosis of rhabdomyosarcoma. He refused adjuvant chemotherapy. After being disease-free for 13 months, he presented with left colic pain. Ultrasound and CT examinations showed a left paraaortic retroperitoneal mass causing grade III ureterohydronephrosis, and lung metastases. Despite rescue chemotherapy treatment, there was no response and the abdominal mass progressed. A surgical approach was not possible since patient showed a rapid clinical worsening leading to his death a few weeks later. CONCLUSIONS: Paratesticular sarcomas are very uncommon tumors with poor prognosis(AU)

Dolor y masa gigante en hipocondrio derecho / Right hypochondrium pain and giant mass

OBJETIVO: Describir un caso de una masa gigante en hipocondrio derecho en un paciente de 40 años. MÉTODOS: Describimos un caso de un paciente de 40 años que consultó por dolor en hipocondrio derecho y aumento del perímetro abdominal. En el estudio radiológico se apreció una masa retroperitoneal de 30 x 24 x 20 cm, dependiente del polo superior del riñón derecho. RESULTADOS: Se realizó nefrectomía radical por laparotomía media. El análisis microscópico demostró que se trataba de un carcinoma renal de células claras pT2bM0N0. CONCLUSIÓN: Existen pocos casos publicados de carcinomas renales con hemorragia intraparenquimatosa mayores de 20 cm, el mayor de ellos, de más de 10 kg, y presentan generalmente una evolución favorable(AU)

OBJECTIVE: To report a case of a right hypochondrium giant mass in a 40-year-old patient. METHODS: We report the case of a 40 year-old male referred to our Department because of right hypochondrium pain and increased abdominal perimeter. Radiological examination showed a 30 x 24 x 20 cm retroperitoneal mass, dependent on the upper pole of the right kidney. RESULTS: We performed radical nephrectomy through a mid line laparotomy. The pathological analysis described it as a clear cell renal carcinoma pT2bN0M0. CONCLUSION: There are few reported cases of renal carcinomas with intraparenchymal bleeding exceeding 20 cm, the largest one exceeding 10 kg, and they usually show a good prognosis(AU)

Right hypochondrium pain and giant mass.

OBJECTIVE: To report a case of a right hypochondrium giant mass in a 40-year-old patient. METHODS: We report the case of a 40 year-old male referred to our Department because of right hypochondrium pain and increased abdominal perimeter. Radiological examination showed a 30 × 24 × 20 cm retroperitoneal mass, dependent on the upper pole of the right kidney. RESULTS: We performed radical nephrectomy through a mid line laparotomy. The pathological analysis described it as a clear cell renal carcinoma pT2bN0M0. CONCLUSION: There are few reported cases of renal carcinomas with intraparenchymal bleeding exceeding 20 cm, the largest one exceeding 10 kg, and they usually show a good prognosis.

In vitro production of haploid cells after coculture of CD49f+ with Sertoli cells from testicular sperm extraction in nonobstructive azoospermic patients.

OBJECTIVE: To isolate CD49f+ cells from testicular sperm extraction (TESE) samples of azoospermic patients and induce meiosis by coculturing these cells with Sertoli cells. DESIGN: Prospective analysis. SETTING: Research center. PATIENT(S): Obstructive azoospermic (OA) and nonobstructive azoospermic (NOA) patients. INTERVENTION(S): TESE, with enzymatic dissociation of samples to obtain a cell suspension, which was cultured for 4 days with 4 ng/mL GDNF. The CD49f+ cells were sorted using fluorescence-activated cell sorting (FACS) as a marker to identify spermatogonial stem cells (SSCs), which were cocultured with Sertoli cells expressing red fluorescent protein (RFP) in knockout serum replacement (KSR) media with addition of 1,000 IU/mL of follicle-stimulating hormone (FSH), 1 µM testosterone, 40 ng/mL of GDNF, and 2 µM retinoic acid (RA) for 15 days in culture at 37°C and 5% CO(2) to induce meiotic progression. Cells were collected and analyzed by immunofluorescence for meiosis progression with specific markers SCP3 and CREST, and they were confirmed by fluorescence in situ hybridization (FISH). MAIN OUTCOME MEASURE(S): Isolation of CD49f+ cells and coculture with Sertoli cells, meiosis progression in vitro, assessment of SSCs and meiotic markers real-time polymerase chain reaction (RT-PCR), immunohistochemical analysis, and FISH. RESULT(S): The CD49f+ isolated from the of total cell count in the TESE samples of azoospermic patients varied from 5.45% in OA to 2.36% in NOA. Sertoli cells were obtained from the same TESE samples, and established protocols were used to characterize them as positive for SCF, rGDNF, WT1, GATA-4, and vimentin, with the presence of tight junctions and lipid droplets shown by oil red staining. After isolation, the CD49f+ cells were cocultured with RFP Sertoli cells in a 15-day time-course experiment. Positive immunostaining for meiosis markers SCP3 and CREST on days 3 to 5 was noted in the samples obtained from one NOA patient. A FISH analysis for chromosomes 13, 18, 21, X, and Y confirmed the presence of haploid cells on day 5 of the coculture. CONCLUSION(S): In vitro coculture of SSCs from TESE samples of NOA patients along with Sertoli cells promoted meiosis induction and resulted in haploid cell generation. These results improve the existing protocols to generate spermatogenesis in vitro and open new avenues for clinical translation in azoospermic patients.

Testicular sperm from patients with obstructive and nonobstructive azoospermia: aneuploidy risk and reproductive prognosis using testicular sperm from fertile donors as control samples.

OBJECTIVE: To establish a baseline incidence of chromosomal abnormalities in testicular sperm of fertile men and to determine the best control sample for comparisons with azoospermic males to estimate their reproductive prognosis. DESIGN: Prospective study. SETTING: Infertility clinic. PATIENT(S): Sixteen obstructive azoospermic (OA) and 19 nonobstructive azoospermic patients (NOA). Control samples were ejaculated sperm from ten fertile donors and testicular sperm from ten other fertile donors. INTERVENTION(S): Fluorescence in situ hybridization (FISH) in sperm. MAIN OUTCOME MEASURE(S): Sperm numerical abnormalities for chromosomes 13, 18, 21, X, and Y; ongoing implantation and pregnancy rates in intracytoplasmic sperm injection (ICSI) cycles. RESULT(S): In control samples, testicular sperm showed higher incidences of diploidy (0.27% vs. 0.10%) and disomy for chromosomes 13 (0.16% vs. 0.07%), 21 (0.25% vs. 0.12%), and sex chromosomes (0.34% vs. 0.21%) than ejaculated sperm. Comparisons with ejaculated control samples showed 12.5% OA and 68.4% NOA patients having significantly higher incidence of sperm chromosomal abnormalities. Compared with testicular control subjects, fewer OA (6.3%) and NOA (42.1%) patients had chromosomally abnormal sperm. NOA patients had lower ongoing implantation and pregnancy rates than OA patients, particularly those with abnormal FISH compared with testicular control samples. CONCLUSION(S): Sperm FISH analysis using testicular sperm control samples better identifies NOA patients with a lower likelihood of reproductive success.

Síndrome de déficit de testosterona y disfunción eréctil / Testosterone deficit syndrome and erectile dysfunction

OBJETIVO: Analizar la relación entre el síndrome de déficit de testosterona (SDT) y la disfunción eréctil y sus implicaciones diagnósticas y terapéuticas.MÉTODO: Revisión bibliográfica mediante la base de datos de Pubmed de la US National Library of Medicine.RESULTADOS: La real prevalencia del SDT es desconocida, debido a la falta de criterios diagnósticos uniformes en cuanto a qué fracción de testosterona debe medirse (total, libre o biodisponible) y cuáles deben ser los valores diagnósticos. A pesar de ello, se estima que entre un 5-15% de varones con disfunción eréctil presentan niveles séricos disminuidos de testosterona. Existe una sólida base experimental que demuestra que la testosterona juega un papel fundamental en la fisiología de la erección, tanto a nivel central como periférico. No obstante, las evidencias obtenidas en humanos no son tan firmes, especialmente en los varones mayores con SDT. Los resultados de algunos meta-análisis demuestran que el tratamiento sustitutivo con testosterona (TST) permite mejorar las erecciones y el deseo sexual. Sin embargo, no todos los varones con SDT se benefician del TST, probablemente porque en algunos casos el origen de la disfunción eréctil es multifactorial. El tratamiento combinado con testosterona más inhibidores de fosofodiesterasa 5 (PDE5) parece ser un recurso adecuado para rescatar pacientes con disfunción eréctil e hipogonadismo que no responden a la monoterapia, ya sea ésta testosterona sóla o inhibidores de PDE5 sólos.CONCLUSIONES: La determinación sistemática de testosterona sérica en los pacientes que consultan por disfunción eréctil es altamente recomendable, ya que el TST permite, en una proporción de pacientes, mejorar las erecciones y el deseo sexual. Además, el TST puede mejorar el resto de síntomas del SDT y aumentar la eficacia de los inhibidores de la PDE5 cuando éstos no son eficaces como monoterapia(AU)

OBJECTIVES: To analyze the relationship between testosterone deficit syndrome (TDS) and erectile dysfunction and its diagnostic and therapeutic implications.METHODS: Bibliographic review in the Pub Med database of the US National Library of Medicine. RESULTS: The real TDS is unknown, due to the lack of uniform diagnostic criteria on what fraction should be measured (total, free or bioavailable) and what the diagnostic values are. Despite this fact, it is estimated that between 5-15% of males with erectile dysfunction show diminished testosterone levels. There is a solid research base demonstrating that testosterone plays an essential role in the physiology of erection, both at central and peripheral levels. Nevertheless, evidence obtained in human studies is not that strong, mainly in old patients with TDS. The results of some metaanalysis show that substitutive treatment with testosterone improves erections and sexual desire. However, not every patient with TDS will benefit from testosterone substitution therapy, probably because in some cases the origin of erectile dysfunction is multifactorial. Combined treatment with testosterone plus phosphodiesterase 5 (PDE 5) seems to be an adequate alternative to rescue patients with erectile dysfunction and hypogonadism not responding to monotherapy, be it with testosterone alone or PDE 5 inhibitors alone.CONCLUSIONS: Systematic determination of serum testosterone in patients consulting for erectile dysfunction is highly recommendable, because testosterone substitution therapy enables, in a number of patients, improvement of erections and sexual desire. Moreover, testosterone substitution therapy may improve the other symptoms of TDS and increase the efficacy of PDE5 inhibitors when they are not effective in monotherapy(AU)

Aneuploidies in embryos and spermatozoa from patients with Y chromosome microdeletions.

In patients with Y chromosome microdeletions and high percentage of numeric chromosome abnormalities detected by fluorescence in situ hybridization on sperm, a high percentage of abnormal embryos was observed compared with oligozoospermic patients without Y chromosome microdeletions, with a significant increase in the percentage of embryos with monosomy X. Differences in fertilization rates between the different patient groups were not observed; however, blastocyst rates were significantly impaired in patients with Y chromosome microdeletions.

Impact of benign prostatic hyperplasia surgery on erectile function.

AIM: We evaluate the prevalence of erectile dysfunction (ED) prior to surgery for benign prostatic hyperplasia (BPH) and changes produced after surgical intervention. PATIENTS AND METHODS: This prospective study included 128 patients treated surgically for BPH. The prevalence of ED was determined before and after surgery according to the International Index of Erectile Function (IIEF). The influence of different clinical variables on erectile function (EF) improvement or deterioration after surgery was determined using uni- and multivariate analyses. RESULTS: Mean IIEF score before surgery was 20.5 +/- 7.6. Overall, ED was absent in 32% of patients, mild in 42%, moderate in 13.3%, and severe in 12.5%. Mean IIEF score following surgery was 21.5 +/- 7.4 (p = n.s.). After surgery EF improved in 26.6% (34/128) of patients and worsened in 18.8% (24/128) (p < 0.05). Analysing the subset of patients with presurgical ED, 39% reported improvement and 21.1% reported worsening of EF postoperatively. None of the variables analyzed showed a significant relationship with improvement or worsening of EF. Only age was related to worsening EF in the subgroup of non-ED patients. CONCLUSIONS: There is a high prevalence of ED amongst candidates for BPH surgery. Although the risk of worsening EF exists postsurgically, an important percentage of ED patients will improve.

Impact of different patterns of sperm chromosomal abnormalities on the chromosomal constitution of preimplantation embryos.

OBJECTIVE: To evaluate the effect of sperm chromosome abnormalities--disomy for sex chromosomes and diploidy--in the chromosomal constitution of preimplantation embryos. DESIGN: Retrospective cohort study. SETTING: Infertility clinic. PATIENT(S): Three groups: 46,XY infertile men with increased incidence of sex chromosome disomy in sperm; 46,XY infertile men with increased diploidy rates in sperm; 47,XYY infertile men with increased sex chromosome disomy and diploidy rates in sperm. INTERVENTION(S): Sperm collection for fluorescence in situ hybridization analysis. Embryo biopsy for preimplantation genetic screening. MAIN OUTCOME MEASURE(S): Frequencies of numerical abnormalities in sperm for chromosomes 13, 18, 21, X, and Y, and in embryos for chromosomes 13, 16, 18, 21, 22, X, and Y. RESULT(S): A significant increase of chromosomally abnormal and mosaic embryos was observed in the three study groups compared with controls. Those sperm samples with increased sex chromosome disomy rates produced significantly higher percentages of aneuploid embryos, with a threefold increase for sex chromosomes. Sperm samples with increased diploidy rates were mainly associated to the production of triploid embryos. CONCLUSION(S): A strong correlation between sperm and embryo chromosomal constitution has been shown in infertile men with 46,XY and 47,XYY karyotypes.

Relevance of testicular sperm DNA oxidation for the outcome of ovum donation cycles.

OBJECTIVE: To determine the relevance of sperm DNA oxidation caused by free radicals in samples obtained via testicular biopsies by means of flow cytometry by correlating the measurements of 8-hydroxy-2'-deoxyguanosine (8-OHdG) with embryo features and pregnancy achievement. DESIGN: Prospective cross-sectional study. SETTING: Private University-affiliated setting. PATIENT(S): Fifty-seven azoospermic patients undergoing testicular sperm extraction (TESE) were analyzed in their corresponding assisted reporductive technology cycles using ovum donation to standardize female's characteristics. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Quantification of the adduct 8-OHdG in testicular tissue samples, and its effect on markers of embryo quality and reproductive success, and its relevance as marker of TESE sperm quality. RESULT(S): We found the status of sperm DNA oxidation to have very little clinical relevance for several parameters of embryo quality, fertilization rates, early (days 2-3) and late (days 5-6) development, and achievement of pregnancy. CONCLUSION(S): The TESE obtained cells from azoospermic males do not possess a DNA oxidation status of significant importance in the success of assisted reproduction treatments, as determined by 8-OHdG measurement of each category of cell ploidy.

[Assymptomatic prostatic infiltration by chronic lymphocytic leukemia]. / Infiltración asintomática de la próstata por leucemia linfática crónica.

OBJECTIVE: Report of a case of leukemic infiltration of the prostate as an incidental CT finding. METHODS: We describe a case of a 60-year-old male suffering from chronic lymphocytic leukemia. A routine-performed CT showed multiple lymphadenopathies and an hypodense area in the left prostatic lobe. The patient was sent to our department to carry out a transrectal ultrasound and prostatic biopsy. He didn't relate any urinary symptoms. RESULTS: By the prostate rectal examination the gland felt hard and with no well defined limits. The transrectal ultrasound showed heterogene parenchyma and several hyperechoic areas by a bad circumscribed prostate. The pathological analysis reported a diffuse infiltration of the gland by chronic lymphocytic leukemia cells. CONCLUSIONS: Although the relapse of hematological tumors to the prostate has been described previously, there is no published case to our knowledge of a leukemic prostate infiltration in an assymptomatic patient as an incidental finding by an imaging procedure.

Infiltración asintomática de la próstata por leucemia linfática crónica / Assymptomatic prostatic infiltration by chronic lymphocytic leukemia

Objetivo: Presentar un caso de infiltración leucémica de la próstata como hallazgo incidental en una prueba de imagen. Métodos: Describimos el caso de un varón de 60 años en seguimiento por una leucemia linfática crónica, al que se realiza un TAC de rutina apreciando adenopatías múltiples y un nódulo hipodenso en el lóbulo prostático izquierdo. El paciente es remitido a nuestro servicio para la realización de ecografía transrectal y biopsias prostáticas. No refiere clínica urinaria. Resultados: Al tacto rectal la próstata está mal delimitada y con aumento difuso de consistencia. La ecografía transrectal muestra una glándula mal delimitada, con parénquima heterogéneo y varias áreas hiperecoicas. El informe anatomopatológico describe la infiltración difusa de la glándula por una leucemia linfática crónica. Conclusiones: Aunque la extensión de tumores hematológicos a la próstata ha sido descrita previamente, no existe en nuestro conocimiento ningún caso publicado de hallazgo incidental en una prueba de imagen de infiltración prostática por leucemia en un paciente asintomático (AU)

Objective: Report of a case of leukemic infiltration of the prostate as an incidental CT finding. Methods: We describe a case of a 60-year-old male suffering from chronic lymphocytic leukemia. A routine-performed CT showed multiple lymphadenopathies and an hypodense area in the left prostatic lobe. The patient was sent to our department to carry out a transrectal ultrasound and prostatic biopsy. He didn’t relate any urinary symptoms. Results: By the prostate rectal examination the gland felt hard and with no well defined limits. The transrectal ultrasound showed heterogene parenchyma and several hyperechoic areas by a bad circumscribed prostate. The pathological analysis reported a diffuse infiltration of the gland by chronic lymphocytic leukemia cells. Conclusions: Although the relapse of hematological tumors to the prostate has been described previously, there is no published case to our knowledge of a leukemic prostate infiltration in an assymptomatic patient as an incidental finding by an imaging procedure (AU)

First report of the absence of viral load in testicular sperm samples obtained from men with hepatitis C and HIV after washing and their subsequent use.

Human immunodeficiency virus and hepatitis C infections are sexually transmitted diseases that require sperm samples to be pretreated to eliminate the viral presence before their safe use in assisted reproduction treatments. In this report we describe our experience with sperm washing protocols applied to sperm cells from testicular biopsies as well as the results obtained in subsequent assisted reproduction treatments on seropositive males that are also azoospermic.

Sperm DNA fragmentation levels in testicular sperm samples from azoospermic males as assessed by the sperm chromatin dispersion (SCD) test.

OBJECTIVE: To analyze sperm DNA fragmentation (SDF) in testicular sperm samples from patients with azoospermia either from spermatogenic failure or from duct obstruction. Several technologies can be applied in the evaluation of SDF, but given the ease and low costs, the sperm chromatin dispersion test (SCD) has emerged as a promising standard. DESIGN: Prospective blind observational cohort study. SETTING: University-affiliated private IVF setting. PATIENT(S): Azoospermic patients from couples undergoing intracytoplasmic sperm injection cycles. INTERVENTION(S): Testicular sperm extraction (TESE). MAIN OUTCOME MEASUREMENT(S): We determined testicular SDF, and a basic comparison between nonobstructive (n = 22) and obstructive azoospermia (n = 40) was performed. We also correlated SDF with embryo quality and pregnancy outcome. RESULT(S): SDF in the testicular sperm of patients with nonobstructive azoospermia was significantly higher, 46.92% (SEM = 4.47), than that of patients with obstructive azoospermia, 35.96% (SEM = 2.63). A moderate relationship between embryo morphology and testicular SDF was detected. Logistic regression analysis of the effect of testicular SDF on pregnancy outcome revealed no significant effect (odds ratio = 1.015). CONCLUSION(S): Ours is the first report of SDF analysis in testicular sperm by using SCD in azoospermia. This result suggests that spermatogenesis failure may result in a severe affectation of sperm DNA integrity. The degree of DNA fragmentation using the SCD test is not reflected in pregnancy chances, and the explanation could be that embryos have been selected.