[Successful testicular sperm extraction in a non-obstructive azoospermic man with severe testicular microlithiasis :...

A 45-year-old man was referred to our hospital for treatment of azoospermia. On physical examination, right testicular volume was 2 ml, left testicular volume was 3 ml, and pubic Tanner stage was 5. Scrotal ultrasonography revealed a high echoic lesion with acoustic shadowing at surfaces of bilateral testes. Semen analysis showed azoospermia and serum follicle stimulating hormone value was high (28.42 mIU/ml). He was diagnosed with non-obstructive azoospermia, and underwent microdissection testicular sperm extraction. Both testes were filled with shiny granular materials. In excised tissue of the testes, seminiferous tubules containing spermatozoa were found and motile spermatozoa were successfully retrieved. The histological examination revealed many small calcifications which had laminated structure. Spermatogenesis was slightly impaired, and Johnsen's score count was 9. Testicular microlithiasis has been reported to be an infrequent condition associated with conditions such as testicular tumors and testicular dysgenesis syndrome. Such a severe testicular microlithiasis has not been reported previously.