A complete dissection of the whole testicular parenchyma is required in most patients with nonobstructive azoospermia to obtain enough good quality testicular spermatozoa for ICSI. (9th December 2022)

• Record Type: Journal Article
• Authors: Caroppo, Ettore; Castiglioni, Fabrizio; Nerva, Franco; Colpi, Elisabetta Maria; Gazzano, Giacomo; Colpi, Giovanni Maria
• Is Part Of: Andrology. Volume 11:Number 3(2023)
• Page Start: 508
• Page End: 514
• Publication Date: 2022-12-09
• Subjects: location of spermatozoa -- microTESE -- nonobstructive azoospermia -- spermatozoa retrieval -- testis histology; Andrology -- Periodicals; 616.65
• DOI: 10.1111/andr.13344
• Languages: English
• ISSNs: 2047-2919

Abstract

Abstract: Background: Due to the heterogeneous distribution of seminiferous tubules (STs) in patients with nonobstructive azoospermia (NOA), retrieving enough good quality spermatozoa for ICSI may require a complete testicular dissection. According to the only available study in this field, spermatozoa may be found in the testis surface in 34.2% of patients, while a deeper testicular dissection is able to provide spermatozoa for ICSI in 28% of those without spermatozoa in the testis surface. Objectives: To determine the probability of finding enough spermatozoa for ICSI at the initial wide incision of the testis in a cohort of men with NOA undergoing microdissection testicular spermatozoa extraction (mTESE). Materials and methods: We evaluated 276 patients, aged 37 (20–62) years, who underwent unilateral (86, 31.15%) or bilateral (190, 68.8%) mTESE from January 2018 through December 2021. During mTESE, the entire surface of the testicular parenchyma was explored first in search for dilated STs: if no/ not enough spermatozoa were retrieved, the deeper portion of the parenchyma was explored. Results: Spermatozoa were retrieved in 137 patients (49.6%). Histopathology demonstrated Sertoli‐cell only syndrome in 65.6% of operated testes, while maturation arrest was found in 19.5%, hypospermatogenesis (HS) in 12.7%, and hyalinosis in 2%. Spermatozoa were obtained from the testis surface in 46 of 276 patients (16.6%), and after a complete dissection in 91 subjects (32.9%). On multivariate logistic regression, only the histopathological subcategory HS was predictive of the chance of retrieving spermatozoa from the surface of the testis (OR 3.24, 95% CI 1.37–7.69, p = 0.007). Discussion: Most patients with NOA, particularly those with unfavorable histopathological patterns, require a complete dissection of the testicular parenchyma to obtain enough good quality for ICSI. Conclusions: By enabling the complete exploration of the testicular parenchyma, mTESE is to be preferred to cTESE to retrieve spermatozoa in patients with NOA.