Comparison between Conventional and Microsurgical Testicular Sperm Extraction in Non-obstructive Azoospermia

Abstract

Purpose: Recovery of the testicular spermatozoa in non-obstructive azoospermic patients after intracytoplasmic sperm injection (ICSI) is a recent advance in the treatment of male infertility. In this study we compared sperm retrieval using microsurgical testicular sperm extraction (TESE) with retrieval by conventional TESE. Materials and Methods: A total of 450 men with non-obstructive azoospermia were included in the study. 277 of these 450 men underwent conventional TESE (Group 1), and the other 173 patients underwent microsurgical TESE (Group 2). Microsurgical TESE was performed by making multiple incisions in the tunica albuginea under surgical microscopy, with avoiding the underlying testicular artery. The seminiferous tubules that appeared dilated and opaque were harvested. The cases were categorized into three groups, that is, the germ cell aplasia group, the maturation arrest group and the hypospermatogenesis group. The sperm retrieval rates for the patients in the three histopathological categories were compared between the two groups. Results: The sperm retrieval rate by conventional TESE was 30.7% and it was 31.4% by microsurgical TESE (p=0.938). For the cases of histologically diagnosed germ cell aplasia the retrieval rate was 11.6% and 21.2%, respectively, for group 1 and group 2 (p=0.026). For the cases of maturation arrest the retrieval rate was 24.4% and 26.0%, respectively, for group 1 and group 2 (p=0.884). For the cases of hypospermatogenesis the retrieval rate was 83.0% and 91.3%, respectively, for group 1 and group 2 (p=0.339). Conclusions: For non-obstructive patients, and especially those with germ cell aplasia, microsurgical TESE can effectively retrieve spermatozoa and minimize the risk of complication. (Korean J Urol 2008;49:88-91) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏