Arteriovenous malformation of scrotum causing virtual azoospermia

We report a case of surgical correction of a scrotal arteriovenous malformation (AVM) that reversed severe oligospermia. A 31-year-old man was found to have virtual azoospermia and left scrotal swelling. The left scrotal mass was diagnosed as a varicocele, but the mass did not resolve after bilateral microsurgical varicocelectomies. Postoperative pelvic arteriography revealed a scrotal AVM that was subsequently embolized. With a microsurgical approach, the mass was excised. Surgical correction of the scrotal AVM resulted in marked improvement in his semen parameters. The effect of the AVM on spermatogenesis was most likely mediated by an elevation in scrotal temperature.