Structural and functional changes to the testis after conventional versus microdissection testicular sperm extraction

Area of Science:

• Reproductive Medicine
• Andrology
• Surgical Techniques

Background:

• Nonobstructive azoospermia presents a significant challenge for male fertility.
• Testicular Sperm Extraction (TESE) is a key procedure for sperm retrieval in such cases.
• Comparing TESE techniques is crucial for optimizing outcomes.

Purpose of the Study:

• To retrospectively compare ultrasound findings and hormonal changes following TESE.
• To evaluate the efficacy and safety of conventional multiple biopsy TESE versus microdissection TESE.
• To assess sperm retrieval and complication rates between the two TESE methods.

Main Methods:

• Retrospective analysis of 543 TESE attempts in 435 men with nonobstructive azoospermia.
• Comparison between conventional open TESE (83 attempts) and microdissection TESE (460 attempts).
• Assessment of sperm retrieval rates, ultrasound-detected complications, and hormonal profiles (testosterone, FSH, LH).

Main Results:

• Microdissection TESE yielded a significantly higher sperm retrieval rate (57%) compared to conventional TESE (32%) (P = 0.0002).
• Fewer acute and chronic ultrasound changes were observed with microdissection.
• Hormonal levels showed transient drops in testosterone, with subsequent recovery, and significant increases in FSH and LH post-TESE.

Conclusions:

• Microdissection TESE offers a superior sperm retrieval rate for nonobstructive azoospermia.
• The microdissection technique is associated with fewer testicular complications compared to conventional TESE.
• While TESE impacts testicular function, microdissection presents a safer and more effective approach.