PD01-08 IS THERE A ROLE FOR SALVAGE OR REDO MICRO-DISSECTION TESTICULAR SPERM EXTRACTION IN NON-OBSTRUCTIVE AZOOSPERMIA?

Abstract

You have accessJournal of UrologyInfertility: Therapy I1 Apr 2018PD01-08 IS THERE A ROLE FOR SALVAGE OR REDO MICRO-DISSECTION TESTICULAR SPERM EXTRACTION IN NON-OBSTRUCTIVE AZOOSPERMIA? Samuel Morris, Tet Yap, Khaled Alkematy, Chirag Bhandari, Pippa Sangster, Majid Shabbir, and Suks Minhas Samuel MorrisSamuel Morris More articles by this author , Tet YapTet Yap More articles by this author , Khaled AlkematyKhaled Alkematy More articles by this author , Chirag BhandariChirag Bhandari More articles by this author , Pippa SangsterPippa Sangster More articles by this author , Majid ShabbirMajid Shabbir More articles by this author , and Suks MinhasSuks Minhas More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.221AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Microdissection testicular sperm extraction (micro-TESE) is increasingly favoured as the primary surgical sperm retrieval (SSR) technique for non-obstructive azoospermia (NOA) due to higher retrieval rates and lower complications compared to conventional testicular sperm extraction (cTESE) or testicular sperm aspiration (TESA). Increasingly patients present for salvage SSR after previous failed retrieval or redo SSR after previous positive retrievals. This study reviews the success of micro-TESE in these settings and explores predictors of successful retrieval. METHODS A total of 153 patients had salvage micro-TESE; Group 1- salvage after previous failed cTESE or TESA (n=123); Group 2- redo after previous successful cTESE or TESA (n=14); Group 3- salvage after previous failed micro-TESE (n=9); Group 4- redo after previous successful microTESE (n=7). Serum FSH, LH and testosterone, testis size and testicular histopathology were analysed as predictive factors for successful SSR in the salvage setting. Statistical significance was taken as p<0.05. RESULTS The mean (range) patient age was 37.2 (22-57). Overall, repeat micro-TESE was successful in 45%. In Group 1, the salvage micro-TESE success rate was 39% (48/123). In Group 2, the redo micro-TESE success rate was 79% (11/14). In Group 3, the salvage micro-TESE success rate was 33% (3/9). In Group 4, the redo micro-TESE success rate was 100% (7/7). Overall, only the presence of hypospermatogenesis was significantly associated with successful SSR in the salvage or redo setting (p=0.013). Age, serum hormones and testicular size were not statistically significant predictors of success. There were no reported cases of testicular atrophy or loss after repeat micro-TESE in this series. CONCLUSIONS With an overall successful repeat SSR rate (45%) close to reported success rates of primary SSR in NOA, men with NOA should not be considered infertile until they have had a micro-TESE and been found to be infertile. In the redo setting, further retrieval with micro-TESE is safe and effective (79-100% success). In those with previous failed micro-TESE, salvage micro-TESE may be a therapeutic option, particularly in those with hypospermatogenesis on initial pathology. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e62-e63 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Samuel Morris More articles by this author Tet Yap More articles by this author Khaled Alkematy More articles by this author Chirag Bhandari More articles by this author Pippa Sangster More articles by this author Majid Shabbir More articles by this author Suks Minhas More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...