Intrasurgical parameters associated with successful sperm retrieval in patients with non‐obstructive azoospermia undergoing salvage microdissection testicular sperm extraction

Abstract

Background: Patients with non-obstructive azoospermia with a previously failed conventional testicular sperm extraction may undergo a salvage microdissection testicular sperm extraction with the probability of successful sperm retrieval being almost dependent upon the number of previous surgical attempts and to different histopathologic categories. Objectives: To determine whether the seminiferous tubules pattern and the histological categories could affect the sperm retrieval rate in patients with non-obstructive azoospermia undergoing salvage microdissection testicular sperm extraction after failed conventional testicular sperm extraction. Materials and methods: Seventy-nine patients undergoing unilateral or bilateral salvage microdissection testicular sperm extraction were evaluated. During microdissection testicular sperm extraction, if present, dilated tubules were retrieved, otherwise,tubules with slightly larger caliber than that of the surroundings were removed. When no dilated tubule or tubule with slightly larger caliber was found, not dilated tubules were excised. A prediction model was built with seminiferous tubules pattern and testis histology as covariates.Results: Sperm retrieval was successful in 30 out of 79 patients. The prediction model correctly classified 88.3% of cases, explained the 29.7% variability of the outcome, and significantly predicted the microdissection testicular sperm extraction outcome with a sensitivity of 67.7% and a specificity of 90.2%, Both tubules with slightly larger caliber and not dilated tubules were negatively associated with the chance of retrieving spermatozoa. Among the histological categories, only early maturation arrest was significant to the model (log(SSR) = 0.57 -1.9SDT -3.3NDT -1.76EMA) (where SSR is sperm retrieval rate, SDT is tubule with slightly larger caliber, NDT is not dilated tubule, and EMA is early maturation arrest). The model had a clearly useful discrimination (area under the curve = 0.814), the estimated performance was 0.8105, and internal calibration was acceptable (p > 0.05).

Intrasurgical Seminiferous Tubular Diameter Correlates with Total Motile Sperm Count in Azoospermia: a Prospective Cohort Study

“…However, the prospective nature of the current work adds strength to the current findings in contrast to the retrospective studies conducted by Caroppo et al (2019) and (2021) [ 20 , 21 ]. Also, the sample size was larger than the 2 aforementioned studies.…”

“…Notably, they used that same magnification power (× 24) to evaluate the seminiferous tubules like ours in the current study [ 20 ]. Additionally, Caroppo et al (2021) conducted another retrospective study on 79 salvage NOA patients who underwent micro-TESE using a higher magnification power (× 36) to evaluate the seminiferous tubules [ 21 ]. They stated similar findings delivered out by their previous study [ 20 , 21 ].…”

“…Additionally, Caroppo et al (2021) conducted another retrospective study on 79 salvage NOA patients who underwent micro-TESE using a higher magnification power (× 36) to evaluate the seminiferous tubules [ 21 ]. They stated similar findings delivered out by their previous study [ 20 , 21 ]. Even though, not all fresh cases with DT in our study had shown eventful micro-TESE as highly dilated tubules (> 400 um) may sometimes be seen in testes of NOA patients showing impaired spermatogenesis with thickened lamina propria because of the increased extra cellular matrix.…”

“…Consistently, it is worth mentioning that the apparent seminiferous tubules caliber may be misleading in patients with maturation arrest due to it’s homogenous appearance making it difficult for the surgeon to discriminate dilated seminiferous tubules compared to the surroundings. [ 21 ].…”

Prediction Models for Successful Sperm Retrieval in Patients with Non-Obstructive Azoospermia Undergoing Microdissection Testicular Sperm Extraction: Is There Any Room for Further Studies?

“…Data from Xu et al [ 51 ] confirmed that HS associates with high SRR (85%) even in patients with previous sperm retrieval attempts, but found lower SRR in patients with SCO (5.5%) and MA (25%) compared to previous reports. Very recently, our group found that early and late MA were associated with the lowest probability of SSR (8.7 and 11.1%, respectively), while sperm was retrieved in 85% of men with HS; SRRs in patients with SCO differed significantly according to the presence (focal SCO) or not (complete SCO) of residual areas of HS (SRR 100% vs. 24.4%, respectively) [ 52 ].…”