Clinical experience with azoospermia: aetiology and chances for spermatozoa detection upon biopsy.

The clinical workup of the infertile male with azoospermia aims at determining the aetiology and estimating the chances of finding spermatozoa by testicular sperm extraction (TESE). To establish prognostic criteria, 1583 consecutive patients with azoospermia consulting the Centre of Reproductive Medicine and Andrology, Münster, a tertiary referral centre, between 1976 and 2009 comprising 9.8% of all patients providing a semen sample were included in this retrospective analysis. The frequencies of diagnoses were as follows: 21% genetic causes (14% Klinefelter syndrome, 1% other chromosomal aberrations, 2% Y-chromosomal microdeletions, 1% hypogonadotropic hypogonadism, 3% congenital bilateral absence of the vas deferens), 31% current or former maldescended testes, varicocele, urogenital infections, 15% malignancies, 11% obstructions, 7% endocrine or other chronic diseases and 12% idiopathic azoospermia. Receiver-operating characteristic curves for chances of finding spermatozoa by testicular biopsy were calculated for testicular volume, serum follicle-stimulating hormone (FSH) and the seminal markers α-glucosidase, fructose and zinc where these data were available (N=283). Histograms of the seminal markers comparing data from men with obstructive azoospermia and normozoospermia visualize their discriminating power. Evidence-based threshold values for high chances of positive testicular biopsy serving as surrogate marker for TESE were derived from the subgroup of men with obstructive azoospermia for testicular volume (≥21mL), FSH (≤10U/L) and seminal α-glucosidase (≤18mU/ejaculate). Fructose and zinc could not predict the chances of finding spermatozoa upon biopsy. Based on these three parameters, positive biopsy and presumably TESE success can be quickly and reliably estimated in everyday practice with the colour-coded figures constructed from these data. As a seminal α-glucosidase reference limit of 18mU/ejaculate can also be used to diagnose congenital bilateral absence of the vas deferens, α-glucosidase (rather than seminal fructose) should be determined as part of the clinical routine when counselling patients before testicular biopsy.

[Specific and aspecific sports activities of patients with Bechterew's disease]. / Spezifische und unspezifische sportliche Aktivitäten von Patienten mit Morbus Bechterew.

Regular physical exercise is a major positive influence for the course of ankylosing spondylitis. By means of a standardized questionnaire, a total of 118 patients (78 male, 40 female) with ankylosing spondylitis were asked about their regular physical activity. The patients' mean age was 47 years, and they have been suffering from the symptoms of the disease for (a mean) 17 years. Twenty-nine percent of the patients practice disease-specific exercises daily. Thirty-nine percent have not received any instructions about the optimal exercises in the previous 5 years. Most information had been given by the physiotherapist at home or at the health resort. Non-specific physical exercises are practiced by half of the patients. Lack of time and lack of motivation are the major factors preventing the patients from greater activity. Deficient mobility was claimed by 37 of the 118 patients to prevent them from practicing sports. Better information, and hence motivation, of the patients are suggested by our findings as the most useful way to foster wider use of physical exercise.