"Second-look" Micro Testicular Sperm Extraction (MicroTESE) in Patients with Non-obstructive Azoospermia Following Histopathological Analysis

Spahović, H.; Alić, Jasmin; Göktolga, Ümit; Lepara, Zahid; Lepara, Orhan; Rama, Admir; Suljevic, Ismet

doi:10.5455/medarh.2020.74.279-284

Cited by 6 publications

(6 citation statements)

References 30 publications

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“…The increased stiffness of KS testes is due to seminiferous tubule hyalinization. However, in our study, we observed obvious seminiferous tubule hyalinization in the testes of 10 participants without KS who had a JS of 1–2, which is consistent with previous research ( 29 ). Seminiferous tubule hyalinization has been reported not only in the testes of those with KS, but also in the undescended testes and testes of patients with severe oligozoospermia or NOA ( 30 ).…”

Section: Discussionsupporting

confidence: 93%

The relationship of testicular stiffness with Johnsen score and sperm retrieval outcome in men with non-obstructive azoospermia

Fu,

Cui,

Tang

2024

Quant Imaging Med Surg

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Background The pathological Johnsen score (JS) is a quantitative histological scoring system used to assess spermatogenesis in men with nonobstructive azoospermia (NOA), while elastic modulus derived from shear wave elastography (SWE) is a diagnostic tool for evaluating spermatogenic dysfunction. In this prospective observational study, we aimed to investigate whether testicular stiffness measured by SWE could serve as a substitute for JS in predicting sperm retrieval outcomes in men with NOA. Methods This prospective cohort study analyzed 140 testes from 115 consecutive outpatient participants with NOA who had sought treatment at the reproductive medical center of a tertiary care hospital between January 2018 and October 2021. Testicular volume, elastic modulus, JS, and sperm retrieval outcomes were calculated. Statistical differences in parameters between the positive and negative sperm retrieval groups were determined using the Mann-Whitney test. Spearman rank correlation analysis was performed to determine the correlations between JS and either testicular volumes or elastic modulus. Receiver operating characteristic (ROC) curves were drawn to evaluate the diagnostic performance of the testicular elastic modulus and testicular volume. Results The JS correlated positively with testicular volume and negatively with the maximum elastic modulus (Emax) and mean elastic modulus (Emean), with correlation coefficients of 0.804, −0.686, and −0.456, respectively (P<0.01). There were significant differences in JS, testicular volume, and Emax between participants with positive and negative sperm retrieval of microdissection testicular sperm extraction (micro-TESE) (P<0.01). ROC curves were plotted for JS, testicular volume, and Emax to distinguish between participants with positive and negative sperm retrieval. The areas under the ROC curves (AUCs) were 0.783 [95% confidence interval (CI): 0.707–0.859; P<0.01], 0.737 (95% CI: 0.651–0.823; P<0.01), and 0.729 (95% CI: 0.643–0.814; P<0.01), respectively. When the cutoff value of JS was 4.5, its sensitivity and specificity were 60.3% and 89.6%, respectively. When the cutoff value of Emax was 3.75 kPa, its sensitivity and specificity were 79.1% and 64.4%, respectively. The sensitivity and specificity were 68.5% and 83.6%, respectively when the cutoff value of testicular volume was 8.17 mL. Emax combined with testicular volume improved this diagnostic value, with an AUC of 0.742 (95% CI: 0.657–0.828; P<0.01), and sensitivity and specificity were 83.6% and 68.5%, respectively. Conclusions Our study suggests that the combination of testicular stiffness and volume measurements may serve as a viable alternative to pathological JS in predicting the likelihood of successful sperm retrieval prior to micro-TESE procedures.

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Section: Discussionsupporting

confidence: 93%

The relationship of testicular stiffness with Johnsen score and sperm retrieval outcome in men with non-obstructive azoospermia

Fu,

Cui,

Tang

2024

Quant Imaging Med Surg

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“…In this study, the most common histological pattern was Sertoli cell only syndrome (58.4%) followed by a mixed pattern (22.8%) while the least represented pattern was GCMA (4.6%). This is in accordance with the study of Spahovic et al [7] and Mushtaq [15]. SCOS is one of the most common, but also the most serious type of nonobstructive azoospermia and can have various etiology, including gonadotropin deficiency, cryptorchidism, orchitis, prostate cancer hormonal therapy, radiation, Klinefelter syndrome [4].…”

Section: Discussionsupporting

confidence: 91%

“…The most common morphological patterns identified in the testicular biopsies of NOA patients following negative sperm retrieval during a micro-TESE procedure are: hypospermatogenesis (HS), germ cell maturation arrest (GCMA), Sertoli-cell only syndrome (SCOS), seminiferous tubule hyalinization (STH) and mixed pattern (MP). Therefore, histopathological analysis is also critical for the proper selection of patients for the "second look" micro-TESE attempt, which increases the possibility for successful infertility treatment [7].…”

Section: Introductionmentioning

confidence: 99%

Histological patterns of testicular biopsy in patients with azoospermia: single-institution experience

Čamdžić,

Muzika,

Čustović

et al. 2023

Acta Marisiensis - Seria Medica

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Objective of this study was to identify the histopathological patterns and their frequency in testicular biopsy specimens from azoospermic patients and to categorize it according to Modified Johnsen scoring system. Methods: Testicular biopsies from male patients with clinical diagnosis of azoospermia were included in this study. All tissue samples were fixed in buffered 10% formalin, routinely processed and stained with Hematoxylin and Eosin. All cases were examined microscopically and categorized according to the histopathological patterns and Modified Johnsen scoring system. Results: Total 219 cases of testicular biopsies from 125 azoospermic male patients were evaluated, with 94 cases of bilateral testicular biopsy. The most prevalent age group was of 30-39 years (66.2%). The most common histological pattern was of Sertoli cell only syndrome (58.4%) while the least represented pattern was germ cell maturation arrest, seen in 4.6% cases. The most common Modified Johnsen score was 2 (66.7%). There was discordance in histologic pattern in both testes in 12.76% of patients who had bilateral testicular biopsy. Conclusion: Our study gives an insight on the most common histopathological patterns of azoospermic patients and emphasizes the need for a better national statistics and epidemiological studies of this entity. It also points out the significance of the bilateral testicular biopsy, as both, diagnostic and therapeutic procedure.

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“…Available data favor the use of micro-TESE as it has fewer operative complications, in addition to a higher success rate of sperm retrieval approaching 50% of the cases. This percentage could even be increased by achieving an optimal pre-operative testosterone serum level of 250 ng dl−1 [19][20][21][22]. Multiple centers started to offer peri-pubertal sperm retrieval through the technique mentioned above with cryopreservation of sperm, under the premise of a higher success rate due to normal hormonal profile and a lesser degree of fibrosis in such an age.…”

Section: Infertilitymentioning

confidence: 99%

An Overview on Klinefelter’s: Clinical Features and Management in Pediatric Population

Alanazi¹,

Wajdi²,

Issa³

et al. 2022

Int j pharm res allied sci

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Klinefelter syndrome is the most common sex chromosome disorder, with a prevalence of 1 in every 660 males, and despite being so prevalent, less than 30% of cases do ever get diagnosed. This is due to the very heterogeneous phenotypic presentations of the patients; failure in early identification of these patients can have dire consequences on those individuals' overall health and life quality as it is a major cause of primary hypogonadism and subsequent infertility, in addition to the increased risk of neoplasms and a plethora of other systemic conditions. Our objective was to look into the literature concerning Klinefelter's: clinical features and management in the pediatric population. PubMed database was used for articles selection, from where the papers were obtained and reviewed. The clinical presentation of Klinefelter syndrome patients can vary dramatically based on the age and severity of the disease. Most cases have near-normal phenotypes during infancy except for extreme phenotypes that could present with micro-pen undescended testis. As the child grows and reaches puberty detection rate increases as signs of normal puberty such as virilization and increase in muscle mass are usually deficient or incomplete. Most cases only picked up during adulthood who presents complaining of infertility. The treatment approach consists of testosterone therapy, assisted fertility, and early detection and treatment of associated complications.

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"Second-look" Micro Testicular Sperm Extraction (MicroTESE) in Patients with Non-obstructive Azoospermia Following Histopathological Analysis

Cited by 6 publications

References 30 publications

The relationship of testicular stiffness with Johnsen score and sperm retrieval outcome in men with non-obstructive azoospermia

The relationship of testicular stiffness with Johnsen score and sperm retrieval outcome in men with non-obstructive azoospermia

Histological patterns of testicular biopsy in patients with azoospermia: single-institution experience

An Overview on Klinefelter’s: Clinical Features and Management in Pediatric Population

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