Semen uric acid crystals in azoospermia linked to Sertoli cell‑only syndrome: A rare case report

The occurrence of crystals in semen is rare, with spermine phosphate crystals being the only type commonly described. Uric acid crystal formation is significantly influenced by pH levels. The present study reported a rare case of uric acid crystals in the semen of a patient with azoospermia associated with Sertoli cell-only syndrome (SCOS). A 28-year-old male with a four-year history of primary infertility underwent clinical assessment, including a normal physical examination with small testes. Seminal fluid analysis revealed abnormal uric acid crystals. Elevated follicle-stimulating hormone, luteinizing hormone and prolactin levels were observed. The diagnosis of SCOS was confirmed through testicular sperm aspiration. Azoospermia is a medical condition characterized by the absence of sperm in the semen, specifically the absence of sperm in the pellet obtained after centrifugation. It is classified into two primary types: Obstructive and non-obstructive azoospermia. Non-obstructive azoospermia is subdivided into three categories: SCOS, hypospermatogenesis and maturation arrest. The occurrence of SCOS in azoospermic males ranges from 26.3 to 57.8%. The diagnosis of azoospermia with SCOS can be achieved through the analysis of multiple semen samples, medical history, physical examination, hormonal analysis, histopathological examination and genetic testing. The presence of uric acid crystals in seminal fluid was first reported in patients with chronic prostatitis symptoms in 2005. Despite the rarity of crystals in semen, uric acid crystals were found in the semen of an azoospermic male with SCOS.