OBJECTIVE:To constitute an appropriate procedure for clinical diagnosis and treatment for men with azoospermia in China.METHODS:Following a procedure which combined the recommendations from WHO, European Association of Urology (EAU), American Urological Association (AUA), American Society for Reproductive Medicine (ASRM) with our own experiences, 1 027 patients with azoospermia were divided into different subtypes according to patients' case histories and outcomes of various routine and specialized examinations. Then appropriate treatments were chosen according to the diagnostic subtypes.RESULTS:There were 516 cases of obstructive azoospermia, 315 of non-obstructive azoospermia and 150 of combined (obstructive and non-obstructive) azoospermia and 46 of azoospermia with special aetiology. Of the 96 patients who adopted surgical intervention, 28 underwent transurethral resection of the ejaculatory ducts, 10 vasovasostomy and 58 vasoepididymostomy. Of the 45 patients who adopted drug intervention, 16 with inflammatory obstructive azoospermia were treated with antibiotics and 29 with hypogonadotropic hypogonadism were treated with hormonal therapy. Of all the subjects, 789 patients chose in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) and 142 chose artificial insemination of donor (AID) or adoption.CONCLUSION:(1) A standard procedure should be established for the diagnosis, classification and treatment of azoospermia; (2) Special examinations and treatments should be given to cases of azoospermia with special aetiology; (3) According to the diagnosis and the patients' conditions, the most appropriate treatment options should be recommended to them; (4) The hereditary factors in azoospermia should be seriously considered, and a genetic work-up and counseling should be offered in such cases.

Objective To investigate the cause of misdiagnosis and the clinical features of 46,XX male syndrome,and to analyze the male sex determination and molecular genetic basis.Method The clinical features,laboratory examinations,cytogenetic and molecular features of 46,XX(SRY positive)male syndrome were analyzed.Combined with literature review,the causes of misdiagnosis,the prevention and treatments of this disease were analyzed.Result The sociopsychology of the patient was male.He came to hospital for gynecomastia,and was misdiagnosed as idiopathic adolescent gynecomastia.And then serum sex hormones gave some clues of this disease.Definite diagnosis was made by karyotype analysis and FISH exanmination.Conclusion The clinical manifestations of 46,XX male syndrome are heterogenous.It also can cause gynecomastia,and be easily misdiagnosed.So comprehensive physical and laboratory tests,including karyotype analysis,are necessary.

Infertility is important issue which affects human reproductive health.It is estimated that chromosomal abnormalities in patients with male infertility account for 2%-8% an average of 5%.And the most common chromosomal abnormality is Klinefelter syndrome.In the past most people considered that patients with Klinefelter syndrome were sterile with no hope for paternity.However with advancements in artificial reproductive techniques the successful birth of healthy children with sperms from men with Klinefelter syndrome have been reported.This paper reviews some new advances in Klinefelter syndrome.

Prune belly syndrome (PBS) is a congenital developmental anomaly of rare occurrence,which is characterized by the clinical manifestations of absence of abdominal musculature,urinary system abnormity and bilateral cryptorchidism.A case of PBS is reported,and some issues about PBS are discussed on basis of literature review in this paper.

<正> 据统计,约15%的高龄夫妇受不育症困扰。其中遗传性因素是导致不育的重要原因之一,大约有15%的男性不育症是由遗传性因素引起,包括染色体异常和单基因突变。估计在男性不育症患者中

目的:对无精子症患者制定合适的临床诊断和治疗流程.方法:结合WHO、欧洲泌尿外科协会(EUA)、美国泌尿外科协会/美国生殖医学会(AUA/ASRM)及本医院泌尿外科的经验,对1 027例无精子症患者根据病史、常规及特殊检查结果进行分类,根据不同的分类选择合适的治疗.结果:梗阻性无精子症516例、非梗阻性无精子症315例、混合性无精子症150例,特殊原因所致的无精子症46例.96例患者接受了手术治疗,其中28例行经尿道射精管切开术、10例行输精管.输精管吻合术、58例行输精管-附睾吻合术.45例患者接受药物治疗,其中16例炎症性梗阻患者给予抗生素治疗、29例低促性腺激素性腺功能低下的患者给予激素治疗.接受体外人工受精/单精子卵泡内注射技术(IVF/ICSI)治疗者789例,供精人工授精(AID)或收养者142例.结论:(1)对于无精子症的诊断、分类以及治疗应建立一个标准的流程;(2)对于特殊病因导致的无精子患者应给予特殊的检查和治疗;(3)根据患者的诊断类型和具体情况给予最合适的治疗方案;(4)应重视无精子患者的遗传因素,给予患者遗传学咨询.