Objective: To compare testicular histopathology of patients withobstructive azoospermia due to different etiologies and at different levelsof obstruction with testicular histology of normozoospermic men .Materials and methods: This retrospective study involvesreevaluation of testicular biopsy slides from 137 patients with obstructiveazoospermia and compare them with testicular biopsy slides from 24normozoospermic subjects. The patients were subdivided according to theetiology of obstruction into two groups: congenital and acquired; andaccording to the level of obstruction into three categories: intra-testicular,epididymal, and high obstruction. Both quantitative and qualitativeevaluations were performed.Results: The percentage of interstitial fibrosis was significantly higherin the obstructive patients compared with the control group (P = 0.004).Adjusted mean late spermatid score was found to be significantly lowerin acquired obstruction compared with the control group (p = 0.028). Oncomparing acquired with congenital obstruction, the difference in thethickening of BM, interstitial fibrosis, and Johnsen score were found tobe statistically significant in favor of congenital obstruction. Whencomparing each level of obstruction with one another, no statisticallysignificant differences were found with reference to histopathologicalfeatures, adjusted mean late spermatid score, and Johnsen score .However, the percentage of interstitial fibrosis was significantly higher inthe obstructive patients on comparing each level of obstruction with thecontrol group. The level of significance increases as the site ofobstruction approaches the testis i.e. P = 0.002 (intratesticular), 0.005(epididymal), and 0.018 (high obstruction). Conclusion: It is concluded that acquired obstruction of the genitaltract is associated with altered testicular architecture and spermatogenicdamage.