Multimodal Ultrasonography Predicts Sperm Retrieval Success in Nonobstructive Azoospermia: A Retrospective Diagnostic Study.

OBJECTIVE: To develop and validate a multimodal ultrasound model integrating testicular volume, contrast-enhanced ultrasound (CEUS) parameters, and shear-wave elastography (SWE) for preoperative prediction of sperm retrieval success in patients with nonobstructive azoospermia (NOA). METHODS: In this retrospective study, 112 NOA patients (224 testes) undergoing microdissection testicular sperm extraction (Micro-TESE) between January 2022 and May 2024 were enrolled. Multimodal ultrasound parameters-including testicular volume (Lambert formula), CEUS-derived arterial transit time (AT), area under the curve (AUC), and SWE stiffness-were compared between successful (n = 88 testes) and failed (n = 136 testes) sperm retrieval groups. Statistical analyses comprised multivariate logistic regression and receiver operating characteristic (ROC) curve evaluation. RESULTS: No significant differences existed in baseline characteristics (age, BMI, lifestyle factors; all p > 0.05). The successful group exhibited larger testicular volume (7.2 ml vs. 6.5 ml; p = 0.007), higher CEUS AUC (474.3 dB·s vs. 340.7 dB·s), and shorter AT (24.9 sec vs. 30.4 sec; p < 0.001). Multivariate analysis confirmed these parameters as independent predictors (volume: OR = 1.144, 95% CI: 1.052-1.245; AT: OR = 0.875, 95% CI: 0.823-0.931; AUC: OR = 1.010, 95% CI: 1.007-1.013; all p < 0.05). The combined model achieved an AUC of 0.861 (95% CI: 0.812-0.911), sensitivity 81.4%, and specificity 75.0%. CONCLUSION: Multimodal ultrasonography provides a clinically valuable, noninvasive tool for predicting sperm retrieval outcomes in NOA. A diagnostic model combining testicular volume, CEUS hemodynamics, and elastography may optimize patient selection for Micro-TESE, reducing unnecessary surgical morbidity.