MP44-16 MICRODISSECTION TESTICULAR SPERM EXTRACTION FOR NON-OBSTRUCTIVE AZOOSPERMIA - IS LONGITUDINAL TESTICULAR INCISION BETTER?

Abstract

You have accessJournal of UrologyInfertility: Therapy I (MP44)1 Apr 2020MP44-16 MICRODISSECTION TESTICULAR SPERM EXTRACTION FOR NON-OBSTRUCTIVE AZOOSPERMIA - IS LONGITUDINAL TESTICULAR INCISION BETTER? Cheng-Han Tsai*, Wei-Jen Chen, I-Shen Huang, and William J. Huang Cheng-Han Tsai*Cheng-Han Tsai* More articles by this author , Wei-Jen ChenWei-Jen Chen More articles by this author , I-Shen HuangI-Shen Huang More articles by this author , and William J. HuangWilliam J. Huang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000899.016AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Microdissection testicular sperm extraction (mTESE) has been the method of choice to retrieve sperm for men with non-obstructive azoospermia (NOA). However, there are controversies on the orientation of incision on the testis while at doing mTESE. Horizontal incision is advocated to avoid damages of the circumferential sub-tunical arteries. The purposes of this study were (1) to analyze the location of sperm yield at mTESE by using longitudinal incision; and (2) to discuss the impact of longitudinal incision to the change of testicular volume. METHODS: A total of 108 men with NOA had sperm identified at mTESE in our institute from 2013 to 2018. The procedure typically started from the larger testis with a longitudinal incision of tunica albuginea. If no sperm was identified, the contralateral testis was then explored. The location of positive sperm yield was categorized into three zones: (1) upper pole, (2) middle part and (3) lower pole of testis. All patients received a therapeutic mTESE at a later session and the testicular size was measured again. RESULTS: Among these men, 87 (80.6%) had sperm identified at the first testicle, and 21 (19.4%) needed to explore the contralateral side. In 71.3% (77/108) men sperm were found only in a single zone and in 28.7% (31/108) sperm were seen in multiple zones. Among patients with sperm retrieval in a single zone, the most popular sites were at the upper pole (45.5%), which was followed by the middle part (31.2%) and the lower pole (23.3%) respectively. Overall, in 38.9% (42/108) men sperm were identified at least in middle area, while in 61.1% (66/108) men sperm were only found at the polar areas. There was no significant difference in demographic data among patients with various sperm presenting patterns. At the later therapeutic mTESE, sperm was successfully retrieved in all patients at the previously registered positive location and there was no testicular atrophy identified. CONCLUSIONS: Based on this study, mTESE using transverse incision might have missed 61.1% chance of sperm retrieval, since sperm are located only at the polar areas in these patients. Therefore, using longitudinal incision for mTESE is more likely to have a thorough exploration of the testicular parenchyma. There was no case of testicular atrophy noted in this series. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e662-e662 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cheng-Han Tsai* More articles by this author Wei-Jen Chen More articles by this author I-Shen Huang More articles by this author William J. Huang More articles by this author Expand All Advertisement PDF downloadLoading ...