Computer-assisted objective evaluation of sperm-containing seminiferous tubule in testicular sperm retrievals

Abstract

ObjectiveThe aim of microdissection testicular sperm extraction (micro-TESE) is to subjectively identify and remove seminiferous tubules (ST) which presumably contain active spermatogenesis based on their apppearance. The purpose of this study was to objectively assess seminiferous tubule diameter using a digital imaging dedicated software and compare tubule diameter in extracted specimens with the presence of testicular sperm.DesignA prospective comparative study.Materials and MethodsFifty-four patients with obstructive (OA) or nonobstructive (NOA) azoospermia undergoing testicular sperm retrieval were included. Testicular parenchyma was excised by TESA and micro-TESE in cases of OA and NOA, respectively, and specimens were sent to the laboratory for analysis. The diameter of the 10 largest seminiferious tubules of each patient were obtained using a digital imaging software coupled to the inverted microscope. Subsequently, ST were mechanically dispersed and processed for sperm search. ST diameter measurements were compared to the presence or absence of testicular sperm in examined specimens.ResultsMean±SD maximal diameter of sperm-containing seminiferous tubules (298±35 micrometers) was significantly higher than non-sperm containing tubules (225±24; KW-H(1;54)=25,213; P<0,0001). The best sensitivity and specificity for a positive result on sperm retrieval was obtained at a cut-off level of 250 micrometers or above.ConclusionObjective assessment of ST diameter is a reliable indicator of sperm presence in testicular retrievals. Identification of ST by size rather than by appearance may be a valid tool to optimize sperm retrieval rates during microdissection testicular sperm extraction. ObjectiveThe aim of microdissection testicular sperm extraction (micro-TESE) is to subjectively identify and remove seminiferous tubules (ST) which presumably contain active spermatogenesis based on their apppearance. The purpose of this study was to objectively assess seminiferous tubule diameter using a digital imaging dedicated software and compare tubule diameter in extracted specimens with the presence of testicular sperm. The aim of microdissection testicular sperm extraction (micro-TESE) is to subjectively identify and remove seminiferous tubules (ST) which presumably contain active spermatogenesis based on their apppearance. The purpose of this study was to objectively assess seminiferous tubule diameter using a digital imaging dedicated software and compare tubule diameter in extracted specimens with the presence of testicular sperm. DesignA prospective comparative study. A prospective comparative study. Materials and MethodsFifty-four patients with obstructive (OA) or nonobstructive (NOA) azoospermia undergoing testicular sperm retrieval were included. Testicular parenchyma was excised by TESA and micro-TESE in cases of OA and NOA, respectively, and specimens were sent to the laboratory for analysis. The diameter of the 10 largest seminiferious tubules of each patient were obtained using a digital imaging software coupled to the inverted microscope. Subsequently, ST were mechanically dispersed and processed for sperm search. ST diameter measurements were compared to the presence or absence of testicular sperm in examined specimens. Fifty-four patients with obstructive (OA) or nonobstructive (NOA) azoospermia undergoing testicular sperm retrieval were included. Testicular parenchyma was excised by TESA and micro-TESE in cases of OA and NOA, respectively, and specimens were sent to the laboratory for analysis. The diameter of the 10 largest seminiferious tubules of each patient were obtained using a digital imaging software coupled to the inverted microscope. Subsequently, ST were mechanically dispersed and processed for sperm search. ST diameter measurements were compared to the presence or absence of testicular sperm in examined specimens. ResultsMean±SD maximal diameter of sperm-containing seminiferous tubules (298±35 micrometers) was significantly higher than non-sperm containing tubules (225±24; KW-H(1;54)=25,213; P<0,0001). The best sensitivity and specificity for a positive result on sperm retrieval was obtained at a cut-off level of 250 micrometers or above. Mean±SD maximal diameter of sperm-containing seminiferous tubules (298±35 micrometers) was significantly higher than non-sperm containing tubules (225±24; KW-H(1;54)=25,213; P<0,0001). The best sensitivity and specificity for a positive result on sperm retrieval was obtained at a cut-off level of 250 micrometers or above. ConclusionObjective assessment of ST diameter is a reliable indicator of sperm presence in testicular retrievals. Identification of ST by size rather than by appearance may be a valid tool to optimize sperm retrieval rates during microdissection testicular sperm extraction. Objective assessment of ST diameter is a reliable indicator of sperm presence in testicular retrievals. Identification of ST by size rather than by appearance may be a valid tool to optimize sperm retrieval rates during microdissection testicular sperm extraction.