MP74-12 IS THERE ANY ROLE OF MEDICAL TREATMENT OR VARICOCELE REPAIR IN INFERTILE MEN WHO FAILED INITIAL TESTICULAR SPERM EXTRACTION?

Abstract

You have accessJournal of UrologyInfertility: Therapy1 Apr 2015MP74-12 IS THERE ANY ROLE OF MEDICAL TREATMENT OR VARICOCELE REPAIR IN INFERTILE MEN WHO FAILED INITIAL TESTICULAR SPERM EXTRACTION? Selahittin Çayan, Abdullah Tok, and Turan Çetin Selahittin ÇayanSelahittin Çayan More articles by this author , Abdullah TokAbdullah Tok More articles by this author , and Turan ÇetinTuran Çetin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2667AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Empirical medical therapy and varicocele repair have been controversial in infertile men with non-obstructive azoospermia. In addition, no evidence based medical treatment has been included to induce spermatogenesis in men who failed initial testicular sperm extraction (TESE) procedure. The aim of this study was to investigate whether there is any role of medical treatment or varicocele repair in azoospermic men who had previous negative TESE procedure. METHODS During a 4 years period, the study included 181 azoospermic men, who failed TESE procedure, who then underwent repeat micro-TESE procedure. All patients were evaluated and treated by a single clinician. The patients were divided into 6 groups according to treatment type. Of the patients, 76 had clinical palpable varicocele on either one or both sides, and 105 had no varicocele. Of the 76 patients with varicocele, 58 had microsurgical subinguinal varicocele repair (Vx): 42 had additional medical treatment (recombinant HCG, anastrozol, or clomiphene citrate), and 16 were followed without additional medical therapy. Eight patients received medical therapy with no Vx treatment, and 10 were only followed with no medical and Vx treatment. Of the 105 men with no clinical varicocele, 90 received medical therapy, and 15 were followed with no treatment. Sperm retrieval rates on micro-TESE were compared according to the treatment groups. RESULTS The mean age was 33.44±6.82 years (21-51), and mean treatment duration prior to re-do micro-TESE was 10.4±3.42 months (6-24). Testicular sperm retrieval rates were 30.9% (13/42) in the men with varicocele who had Vx repair+medical treatment, 12.5% (1/8) in the men with varicocele who had no Vx treatment, but medical treatment, 18.7% (3/16) in the men with varicocele who had only Vx treatment with no medical treatment, 0% (0/10) in the men with varicocele who were followed with no Vx treatment or medical treatment, 18.8% (17/90) in the men with no varicocele who had only medical treatment, and 6.7% (1/15) in the men with no varicocele who were followed only with no medical treatment. CONCLUSIONS Benefit of pre-medical treatment prior to micro-TESE is limited in selected cases. Men with varicocele who failed initial TESE had higher sperm retrieval rate with varicocele repair than men having no varicocele repair. The highest sperm retrieval rate was achieved with varicocele repair plus medical treatment with recombinant HCG. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e943-e944 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Selahittin Çayan More articles by this author Abdullah Tok More articles by this author Turan Çetin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...