Longitudinal vs horizontal capsular incision! Does it alter micro-TESE outcome?

Abstract

Micro-TESE (Testicular Sperm Extraction), a procedure performed for treatment of Non-Obstructive Azoospermia, a leading infertility issue among males globally accounting for about 7% of the male population. Azoospermia is the absence of sperms in ejaculate upon semen analysis, 2% of the global population has encountered. A lot is discussed upon sperm retrieval success in both variants of Micro-TESE, which are Transverse or horizontal and longitudinal or vertical approaches, established studies have identified about 45% to 65% of success retrieving spermatozoa. The objective is the identification of the success of both the variants of procedure separately and also of postop complications to both approaches for micro-TESE. A cohort study, for which data, secondary (retrospective), was obtained from King Abdulaziz Medical City (KAMC), Riyadh. The time frame for data covered January 2016 to November 2018; 87 patients underwent micro-TESE, as in the logbook available in “Best Care System at KAMC. Data obtained was analyzed using SPSS Software, 87 of these patients who underwent micro-TESE procedure, 45 were done with the transverse approach and 42 with longitudinal approach, accounting for 51.7% and 48.3%, respectively. Upon postop evaluation, in the transverse approach, sperm were retrieved in 25.29% and for the longitudinal approach, retrieval was about 19.54%. The success rate was 48.9% out of 45 procedures in the transverse approach and 40.5% out of 42 procedures in the vertical/Longitudinal approach. The most common reported post-operative complication in transverse type was atrophy 20% and pain 13.3% on other hand common complications recorded for vertical type, atrophy was about 17.2% and pain in12.6% of patients. Not much statistical significance was observed between the transverse and longitudinal approach in either of the outcomes whether it is success rate or post-op complications. Both approaches are influenced by the factors of surgeon expertise and certain other factors that include pre and postop hormonal therapy, baseline hormonal status, and ICSI.