Outcome of microdissection TESE compared with conventional TESE in non‐obstructive azoospermia: a systematic review

Abstract

SUMMARYRetrieval of spermatozoa is unfortunately still only successful in a subset of patients suffering from non-obstructive azoospermia (NOA) by conventional testicular sperm extraction (TESE). Microdissection TESE may have some theoretical benefits over conventional TESE, but uncertainty exists about its superiority. The objective of this systematic review was therefore to compare the efficacy and safety of microTESE with conventional TESE in men with NOA. The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Literature was searched for studies comparing outcome of conventional TESE with microdissection TESE. Primary outcome was sperm retrieval rate (SRR). Secondary outcomes were clinical predictors of sperm retrieval as well as complication rate. Of 62 articles, a total of seven studies were included in the final analysis. Overall SRR was significantly higher in the microTESE group in comparison with conventional TESE in five of these studies. Overall sperm retrieval ranged from 16.7 to 45% in the conventional TESE vs. 42.9 to 63% in the microTESE group. A sub-analysis of the SRR according to testicular histology was available in four of the selected articles. MicroTESE in men with Sertoli cell only syndrome and hypospermatogenesis carried a small but significant more favourable outcome according to, respectively, two and one of the studies. Correlation of serum follicle stimulating hormone and testicular volume with positive outcome was variable. Fewer complications were observed on ultrasound examination after microTESE procedure. Clinical randomized studies comparing microTESE with conventional TESE in NOA are still lacking to date. Pseudo-randomized prospective data, however, show more favourable sperm retrieval in NOA for microTESE, especially in histological patterns of patchy spermatogenesis such as Sertoli cell only syndrome. However, in patients with uniform histological patterns such as maturation arrest outcome of microTESE seems less favourable.

Testicular histology may predict the successful sperm retrieval in patients with non-obstructive azoospermia undergoing conventional TESE: a diagnostic accuracy study

“…Such reports could provide valuable information to assist the urologist in choosing the more appropriate surgical technique of sperm retrieval for another surgical attempt. As suggested by the results of the latest systematic reviews [24,25], microTESE may perform better in patients w i t h S C O o r M A , w h i l e i n p a t i e n t s w i t h hypospermatogenesis, TESE and microTESE yield comparable sperm retrieval rates. Consequently, among patients with sperm retrieval failure, those with histology of HYPO could be suggested to undergo another TESE attempt rather than considering to undergo the more invasive microTESE.…”

Conventional testicular sperm extraction (TESE) and non‐obstructive azoospermia: is there still a chance in the era of microdissection TESE? Results from a single non‐academic community hospital

“…In many referral fertility centres, c-TESE has been replaced by micro-TESE, because most of infertile couples ask for this procedure during their first consultation (Deruyver et al, 2014;Bernie et al, 2015). Nevertheless, it should be considered that micro-TESE requires magnification equipment, which means higher costs, longer operative times and it is associated with a significant learning curve.…”

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

“…In men with non-obstructive azoospermia, the alternative sperm retrieval procedures are single or multiple random conventional TESE (testicular sperm extraction, open or percutaneous), and single or multiple testicular FNA (fine needle aspiration). To date, the data indicate that micro-TESE is associated with higher sperm retrieval rates and lower complication rates than conventional TESE or testicular FNA (Ramasamy et al, 2005;Donoso et al, 2007;Deruyver et al, 2014).…”

“…Etiologies of testicular failure include endocrine dysfunctions, genetic disorders, cryptorchidism, testicular torsion, radiation, and toxins Anniballo et al, 2000;Ezeh, 2000;Raman & Schlegel, 2003;Donoso et al, 2007). In men with non-obstructive azoospermia, microdissection testicular sperm extraction (micro-TESE) is considered the optimal method of sperm retrieval with sperm retrieval rates in the range 40-60% (Donoso et al, 2007;Schlegel, 2009;Deruyver et al, 2014). The procedure involves a meticulous microsurgical exploration of the testicular parenchyma to search for dilated seminiferous tubules (these dilated tubules often contain spermatozoa).…”