The family history needs to be assessed to look for genetic abnormalities.Congenital absence of the vas deferens may be detectable on physical examination and can be confirmed by a transrectal ultrasound (TRUS). If confirmed, genetic testing for cystic fibrosis is in order. Transrectal ultrasound can also assess azoospermia caused by obstruction, or anomalies related to obstruction of the ejaculatory duct, such as abnormalities within the duct itself, a median cyst of the prostate (indicating a need for cyst aspiration), or an impairment of the seminal vesicles to become enlarged or emptied. Retrograde ejaculation is diagnosed by examining a post-ejaculatory urine for presence of sperm after making it alkaline and centrifuging it.Low levels of LH and FSH with low or normal testosterone levels are indicative of pretesticular problems, while high levels of gonadotropins indicate testicular problems. However, often this distinction is not clear and the differentiation between obstructive versus non-obstructive azoospermia may require a testicular biopsy. On the other hand, "In azoospermic men with a normal ejaculate volume, FSH serum level greater than two times the upper limit of the normal range is reliably diagnostic of dysfunctional spermatogenesis and, when found, a diagnostic testicular biopsy is usually unnecessary, although no consensus exists in this matter."
Keratoderma is a hornlike skin condition. Classification
The keratodermas are classified into the following subgroups:: 506

Congenital
Simple keratodermas
Diffuse palmoplantar keratodermas
Diffuse epidermolytic palmoplantar keratoderma
Diffuse nonepidermolytic palmoplantar keratoderma
mal de Meleda
Focal palmoplantar keratoderma
Striate palmoplantar keratoderma
Punctate palmoplantar keratoderma
Keratosis punctata palmaris et plantaris
Spiny keratoderma
Focal acral hyperkeratosis
Complex keratodermas
Diffuse palmoplantar keratoderma
Erythrokeratodermia variabilis
Palmoplantar keratoderma of Sybert
Olmsted syndrome
Naegeli–Franceschetti–Jadassohn syndrome
Focal palmoplantar keratoderma
Papillon–Lefèvre syndrome
Pachyonychia congenita type I
Pachyonychia congenita type II
Focal palmoplantar keratoderma with oral mucosal hyperkeratosis
Camisa disease
Ectodermal dysplasias
Cloustons hidrotic ectodermal dysplasia
Acrokeratotic poikiloderma
Dermatopathic pigmentosa reticularis
Syndromic keratodermas
Vohwinkel syndrome
Palmoplantar keratoderma associated with esophageal cancer
Palmoplantar keratoderma and spastic paraplegia
Naxos disease
Striate palmoplantar keratoderma, woolly hair, and left ventricular dilated cardiomyopathy
Keratitis-ichthyosis-deafness syndrome
Corneodermatosseous syndrome
Huriez syndrome
Oculocutaneous tyrosinemia
Cardiofaciocutaneous syndrome
Schöpf–Schulz–Passarge syndrome

Acquired
Acquired keratodermas
AIDS-associated keratoderma
Arsenical keratoses
Calluses
Climacteric keratoderma
Clavi (Corns)
Eczema
Human papillomavirus
Keratoderma blenorrhagicum
Lichen planus
Norwegian scabies
Paraneoplastic keratoderma
Psoriasis
Reactive arthritis
Secondary syphilis
Tinea pedis
Sézary syndrome
Tuberculosis verrucosa cutis
Drug-induced keratoderma

See also
Palmoplantar keratoderma
Skin lesion
List of cutaneous conditions
List of conditions caused by problems with junctional proteins

References


== External links ==