1988 LOCALIZATION OF SPERM DURING MICRODISSECTION TESICULAR SPERM EXTRACTION FOR MEN WITH NONOBSTRUCTIVE AZOOSPERMIA

You have accessJournal of UrologyInfertility: Therapy1 Apr 20121988 LOCALIZATION OF SPERM DURING MICRODISSECTION TESICULAR SPERM EXTRACTION FOR MEN WITH NONOBSTRUCTIVE AZOOSPERMIA Ranjith Ramasamy, Jad Husseini, Jennifer Reifsnyder, Campbell Bryson, Pierre-Alexandre Eid, and Peter Schlegel Ranjith RamasamyRanjith Ramasamy New York, NY More articles by this author , Jad HusseiniJad Husseini New York, NY More articles by this author , Jennifer ReifsnyderJennifer Reifsnyder New York, NY More articles by this author , Campbell BrysonCampbell Bryson New York, NY More articles by this author , Pierre-Alexandre EidPierre-Alexandre Eid New York, NY More articles by this author , and Peter SchlegelPeter Schlegel New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2149AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Microdissection testicular sperm extraction (TESE) involves a meticulous search for sperm containing seminiferous tubules in men with nonobstructive azoospermia. There are currently no data characterizing the location in which these tubules are identified. The objective of this study was to determine the location were sperm was identified during microdissection TESE and to characterize the subset of patients for whom complete bilateral exploration is most beneficial. METHODS A total of 900 men underwent their first attempt at microdissection TESE from 2000 - 2010. Microdissection TESE was started on the larger testis and performed in a stepwise fashion where testicular tissue samples were sequentially removed and analyzed by an embryologist intraoperatively. If no sperm were identified, extensive microdissection of the deeper tissue in the upper and lower poles was performed. A similar technique was performed on the contralateral (smaller) testis if no sperm were found on the initial side. Patient age, preoperative testosterone, FSH, testicular volume, sperm retrieval rate, and pregnancy outcomes were recorded. RESULTS A total of 474 men (52.6%) had sperm identified after their first microdissection TESE. Of the 374 men who had successful sperm retrieval, 245 (65%) had sperm identified through the initial wide incision alone. Men with lower preoperative FSH level, larger testis volume, history of varicocele, and hypospermatogenesis on a preoperative diagnostic biopsy had a higher chance of finding sperm with the initial wide incision alone (p<0.05). Of the 566 men who underwent bilateral microdissection TESE, only 40 men (7%) had sperm found on the contralateral side following no sperm identified on the initial side. For men with Klinefelter syndrome and a smaller testis, the chance of sperm retrieval on the contralateral side after a negative unilateral microdissection was higher (p<0.05). CONCLUSIONS Men with nonobstructive azoospermia benefit from complete exploration of the testes bilaterally for identification of sperm. Upto 7% of men, who have no sperm identified on initial testis will have sperm on the contralateral side and upto 35% of men who have no sperm on the initial wide incision alone will have sperm discovered during deep microdissection TESE. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e802 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ranjith Ramasamy New York, NY More articles by this author Jad Husseini New York, NY More articles by this author Jennifer Reifsnyder New York, NY More articles by this author Campbell Bryson New York, NY More articles by this author Pierre-Alexandre Eid New York, NY More articles by this author Peter Schlegel New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...