Editing CUA: Azoospermia (2015) (section)

== Reduced semen volume (<1.5mL) azoospermia ==

* '''Most of the semen comes from the seminal vesicles (largest contributor) and prostate (>90%)'''
* '''Etiology (5) A Reduced Semen Volume Etiology Exercise:'''
*# '''Artifact: missed the container, difficulty providing specimen'''
*# '''Retrograde ejaculation'''
*# '''Seminal Vesicles obstruction or abnormality'''
*# '''Ejaculatory duct obstruction'''
*# '''Emission failure (psychogenic failure, diabetes, spinal cord injury, RPLND, etc.)'''
* '''Diabetic men often have retrograde ejaculation or failure of emission'''
* '''Investigations (sequential):'''
*# '''Rule out artifact (then)'''
*# '''Rule out retrograde ejaculation by testing the post-ejaculate urine for the presence of sperm (then)'''
*#* Sperm in the post-ejaculation urine is diagnostic of retrograde ejaculation
*# '''Transrectal ultrasound (TRUS) to identify reproductive tract obstruction or abnormalities'''
*#* '''Obstruction of the ejaculatory duct is usually detected by a TRUS and is usually accompanied by dilation of the seminal vesicles (typically >1.5 cm wide)'''
** '''Vasography is not required and should be discouraged for men with an ejaculatory duct obstruction'''