Abstract
Background: Identification of healthy looking testicular tissue is the rationale behind successful microdissection testicular sperm extraction (TESE). Objective: To determine sensitivity, specificity and accuracy of intraoperative microscopic findings during microdissection TESE as correlated to successful sperm retrieval. Patients and Methods: A consecutive 100 primary infertile men with non-obstructive azoospermia were prospectively enrolled for microdissection TESE in a single tertiary academic center. Under anesthesia, testicular parenchyma was examined at high magnification to identify dilated, opaque or whitish tubules which are considered to contain spermatozoa. Additionally 2 samples were taken from the adjacent tissues of non-dilated tubules for sperm retrieval and histological examination. If no dilated tubules were observed, multiple samples were randomly excised from middle and polar areas. Results: The mean age was 36.4 ± 8.4 years and the mean duration of infertility was 9.1 ± 7.2 years. Both testes were explored in 68 patients and one was examined in 32. Microdissection TESE retrieved mature spermatozoa in 33 patients (33%). A total of 168 testes were examined and the foci of healthy looking testicular tissue were identified in 44 (26.2%). A false positive result (dilated tubules with no sperms retrieved) was encountered in 10 cases. A false negative result (no dilated tubules were identified in spite of retrieval of mature sperms) was found in 3 cases. The over all sensitivity, specificity and accuracy of the examined testes were 91.9, 92.4 and 92.3 %, respectively. Hypospermatogenesis had the highest sperm retrieval rate. Sperm retrieval rate was not related to serum follicle-stimulating hormone, testosterone or previous sperm retrieval interventions but to the most advanced pattern of testicular histology (p = 0.027). Conclusion: Identification of healthy looking testicular tissue during microdissection TESE is highly sensitive, specific and accurate for successful sperm retrieval. Our results prove the rationale behind the procedure.
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