Conventional testicular sperm extraction combined with the microdissection technique in nonobstructive azoospermic patients: a prospective comparative study

Turunç, Tahsin; Gül, Ümit; Haydardedeoğlu, Bülent; Bal, Nebil; Kuzgunbay, Barış; Peşkircioğlu, Levent; Özkardeş, Hakan

doi:10.1016/j.fertnstert.2010.01.008

Cited by 81 publications

(72 citation statements)

References 17 publications

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“…The incidence of post-sperm retrieval complications ranges from 0-70% and include persistent pain, swelling, infection, hydrocele and hematoma (18)(19)(20)(21). Complication rates vary according to the sperm retrieval technique and to a lesser extent to the type of azoospermia.…”

Section: Sperm Retrieval Postoperative Care and Complicationsmentioning

confidence: 99%

“…However, it has been reported that large-volume conventional TESE is associated with a higher risk of transient or even permanent decrease in serum testosterone levels due to testicular devascularization (19,22). The incidence of complications following micro-TESE is lower than conventional TESE (17,19,21,23). Using micro-TESE, identification of testicular vessels under the tunica albuginea is made prior to the placement of an incision into the testis.…”

Section: Sperm Retrieval Postoperative Care and Complicationsmentioning

confidence: 99%

“…Testicular sperm have been obtained in all etiology categories of cryptorchidism, orchitis, genetic, radio-/chemotherapy and idiopathic (5,6,10,17,18,21,23). Efficiency of sperm retrieval in NOA males varies according to the method of sperm collection.…”

Section: Non-obstructive Azoospermiamentioning

confidence: 99%

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Sperm retrieval techniques for assisted reproduction

Esteves¹,

Miyaoka²,

Agarwal³

2011

Int. braz j urol.

125

117

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Different surgical methods such as PESA, MESA, TESA, TESE and micro-TESE have been developed to retrieve spermatozoa from either the epididymis or the testis according to the type of azoospermia, i.e., obstructive or non-obstructive. Laboratory techniques are used to remove contaminants, cellular debris, and red blood cells following collection of the epididymal fluid or testicular tissue. Surgically-retrieved spermatozoa may be used for intracytoplasmic sperm injection (ICSI) and/or cryopreservation. In this article, we review the surgical procedures for retrieving spermatozoa from both the epididymis and the testicle and provide technical details of the commonly used methods. A critical analysis of the advantages and limitations of the current surgical methods to retrieve sperm from males with obstructive and non-obstructive azoospermia is presented along with an overview of the laboratory techniques routinely used to process surgically-retrieved sperm. Lastly, we summarize the results from the current literature of sperm retrieval, as well as the clinical outcome of ICSI in the clinical scenario of obstructive and nonobstructive azoospermia.

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Section: Sperm Retrieval Postoperative Care and Complicationsmentioning

confidence: 99%

Section: Sperm Retrieval Postoperative Care and Complicationsmentioning

confidence: 99%

See 1 more Smart Citation

Sperm retrieval techniques for assisted reproduction

Esteves¹,

Miyaoka²,

Agarwal³

2011

Int. braz j urol.

125

117

View full text Add to dashboard Cite

show abstract

“…As a result and because of the relatively high SRR and low reported complication rates (Schlegel, 1999;Amer et al, 2000;Okada et al, 2002;Tsujimura et al, 2002;Ramasamy et al, 2005;Turunc et al, 2010;Ghalayini et al, 2011) many centers use mTESE as the first choice of retrieving spermatozoa in NOA. However, this global approach does not allow for individualized treatment based on the patients needs.…”

Section: Discussionmentioning

confidence: 99%

Multiple needle‐pass percutaneous testicular sperm aspiration as first‐line treatment in azoospermic men

et al. 2016

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SUMMARYPercutaneous testicular sperm aspiration (TESA) has been known for decades as a simple, minimally invasive approach to sperm retrieval in azoospermic men. Because of lower reported sperm retrieval rates (SRR) when compared with microdissection testicular sperm extraction (mTESE), many centers now use mTESE as the first choice for retrieving spermatozoa in nonobstructive azoospermia (NOA). Objectives of this study were to evaluate the outcome and safety of TESA and mTESE in the treatment of azoospermia and to investigate the usefulness of a prognostic TESA to individualize protocols for couples and limit the use of invasive testicular procedures. IRB approval was obtained to retrospectively evaluate 208 patients undergoing multiple needle-pass TESA between 1999 and 2014. Prognostic TESA was performed on 125 men with NOA and 82 with obstructive azoospermia (OA). Nine NOA men and 31 OA men with previously demonstrated spermatozoa had a subsequent therapeutic TESA while nine NOA men with a failed TESA proceeded to mTESE. Main outcome measures were complication rates and SRR. SRR of the prognostic TESA was 30% (38/125) for NOA men and 100% (82/82) for OA men. Eight/nine NOA men and 31/31 OA men had spermatozoa found for intracytoplasmic sperm injection in a subsequent therapeutic TESA. In nine NOA men in whom a TESA produced no spermatozoa, only one had spermatozoa found with mTESE. Overall complication rates of TESA and mTESE were 3% (7/267) and 21% (3/14), respectively. TESA provides reasonable SRR and is a safe procedure. Successful prognostic TESA indicates future success with therapeutic TESA. Men with a failed TESA have a limited chance of sperm retrieval using mTESE. Approaching azoospermic men with an initial prognostic TESA followed by either therapeutic TESA and/or mTESE is an efficient algorithm in the management of azoospermia and limits the use of more invasive procedures.

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“…As part of the procedure, most centers perform an immediate (intra-operative) microscopic assessment of the extracted testicular tissue. This will help to guide the surgeon as to whether he/she should continue extracting tissue in the ipsilateral and/or contra-lateral testis or terminate the procedure (Tsujimura et al, 2002;Turunc et al, 2010;Ramasamy et al, 2011Ramasamy et al, , 2013.…”

Section: Introductionmentioning

confidence: 99%

Can the rapid identification of mature spermatozoa during microdissection testicular sperm extraction guide operative planning?

Alrabeeah

Doucet²,

Boulet³

et al. 2015

Andrology

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SUMMARYThe minimum sperm count and quality that must be identified during microdissection testicular sperm extraction (micro-TESE) to deem the procedure successful remains to be established. We conducted a retrospective study of 81 consecutive men with nonobstructive azoospermia who underwent a primary (first) micro-TESE between March 2007 and October 2013. Final assessment of sperm recovery [reported on the day of (intracytoplasmic sperm injection) ICSI] was recorded as (i) successful (available spermatozoa for ICSI) or (ii) unsuccessful (no spermatozoa for ICSI). The decision to perform a unilateral (with limited or complete microdissection) or bilateral micro-TESE was guided by the intra-operative identification of sperm recovery (≥5 motile or non-motile sperm) from the first testicle. Overall, sperm recovery was successful in 56% (45/81) of the men. A unilateral micro-TESE was performed in 47% (38/81) of the men (based on intra-operative identification of sperm) and in 100% (38/38) of these men, spermatozoa was found on final assessment. In 42% (16/38) of the unilateral cases, a limited microdissection was performed (owing to the rapid intraoperative identification of sperm). The remaining 43 men underwent a bilateral micro-TESE and 16% (7/43) of these men had sperm identified on final assessment. The cumulative ICSI pregnancy rates (per cycle started and per embryo transfer) were 47% (21/45) and 60% (21/35), respectively, with a mean (AESD) of 1.9 AE 1.0 embryos transferred. The data demonstrate that intra-operative assessment of sperm recovery can correctly identify those men that require a unilateral micro-TESE. Moreover, the rapid identification of sperm recovery can allow some men to undergo a limited unilateral micro-TESE and avoid the need for complete testicular microdissection.

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Conventional testicular sperm extraction combined with the microdissection technique in nonobstructive azoospermic patients: a prospective comparative study

Cited by 81 publications

References 17 publications

Sperm retrieval techniques for assisted reproduction

Sperm retrieval techniques for assisted reproduction

Multiple needle‐pass percutaneous testicular sperm aspiration as first‐line treatment in azoospermic men

Can the rapid identification of mature spermatozoa during microdissection testicular sperm extraction guide operative planning?

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