Conventional Versus Microdissection Testicular Sperm Extraction for Nonobstructive Azoospermia

Abstract

No AccessJournal of UrologyCLINICAL UROLOGY: ORIGINAL ARTICLES1 Sep 2002Conventional Versus Microdissection Testicular Sperm Extraction for Nonobstructive Azoospermia Hiroshi Okada, Masaki Dobashi, Takafumi Yamazaki, Isao Hara, Masato Fujisawa, Soichi Arakawa, and Sadao Kamidono Hiroshi OkadaHiroshi Okada , Masaki DobashiMasaki Dobashi , Takafumi YamazakiTakafumi Yamazaki , Isao HaraIsao Hara , Masato FujisawaMasato Fujisawa , Soichi ArakawaSoichi Arakawa , and Sadao KamidonoSadao Kamidono View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64575-2AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We established a practical and safe strategy for testicular sperm extraction (TESE) in patients with nonobstructive azoospermia and compared conventional with microdissection TESE. Materials and Methods: In a retrospective comparative study 46 patients, including 22 with obstructive and 24 with nonobstructive azoospermia, underwent conventional TESE. Another 100 patients, including 26 with obstructive and 74 with nonobstructive azoospermia, underwent microdissection TESE. Conventional TESE was performed via 3 small 5 mm. incisions in the tunica albuginea. Microdissection TESE was performed by making a 3 to 4 cm. incision in the tunica albuginea under operating microscopy, avoiding the underlying testicular artery. Seminiferous tubules that appeared dilated and opaque were harvested. Sperm recovery rates were compared, as were complication rates assessed by ultrasonographic and endocrinological evaluations. Results: In obstructive azoospermia cases the sperm recovery rate was 100% for each procedure. In nonobstructive azoospermia cases sperm were recovered in 16.7% and 44.6% by conventional and microdissection TESE, respectively (p = 0.0271). In cases of histologically diagnosed maturation arrest the sperm recovery rate was 37.5% and 75%, respectively (p = 0.22585). In cases of the Sertoli-cell-only syndrome the sperm recovery rate was 6.3% and 33.9%, respectively (p = 0.0494). We identified dilated and opaque seminiferous tubules containing spermatozoa under operating microscopy in 22.2% of patients with maturation arrest and in 63.2% with the Sertoli-cell-only syndrome. The complication rate was significantly lower for microdissection than for conventional TESE. Conclusions: In nonobstructive cases, especially those of the Sertoli-cell-only syndrome, microdissection TESE can effectively retrieve spermatozoa and minimize the risk of complications. References 1 : Pregnancy after fertilisation with human testicular spermatozoa. Lancet1993; 342: 1237. Crossref, Medline, Google Scholar 2 : The use of epididymal testicular spermatozoa for intracytoplasmic sperm injection: the genetic implications for male infertility. 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