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Efficacy of stepwise mini-incision microdissection testicular sperm extraction for nonobstructive azoospermia with
Yu-Xiang Zhang1, Chen-Cheng Yao, Yu-Hua Huang
1Department of Andrology, The Center for Men's Health, Urologic Medical Center, Shanghai Key Laboratory of Reproductive Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China.
Abstract:
Stepwise mini-incision microdissection testicular sperm extraction (mTESE) is a procedure that attempts to minimize testicular damage. However, the mini-incision approach may vary in patients with different etiologies. Here, we performed a retrospective analysis of 665 men with nonobstructive azoospermia (NOA) who underwent stepwise mini-incision mTESE (Group 1) and 365 men who underwent standard mTESE (Group 2). The results showed that the operation time (mean ± standard deviation) for patients with successful sperm retrieval in Group 1 (64.0 ± 26.6 min) was significantly shorter than that in Group 2 (80.2 ± 31.3 min), with P <0.001. The total sperm retrieval rate (SRR) was 23.1% in our study, and there was no significant difference between Group 1 and Group 2 ( P >0.05), even when the etiologies of NOA were taken into consideration. The results of consecutive multivariate logistic regression analysis (odds ratio [OR]: 0.57; 95% confidence interval [CI]: 0.38-0.87; P =0.009) and receiver operating characteristic (ROC) analysis (area under the ROC curve [AUC]=0.628) showed that preoperative anti-Müllerian hormone (AMH) level in idiopathic NOA patients was a potential predictor for surgical outcomes after initial three small incisions made in the equatorial region without sperm examined under an operating microscope (Steps 2-4). In conclusion, stepwise mini-incision mTESE is a useful technique for NOA patients, with comparable SRR, less surgical invasiveness, and shorter operation time compared with the standard approach. Low AMH levels may predict successful sperm retrieval in idiopathic patients even after a failed initial mini-incision procedure.
Insights
Stepwise mini-incision microdissection testicular sperm extraction (mTESE) offers comparable sperm retrieval rates to standard mTESE but with reduced operation time and invasiveness for nonobstructive azoospermia (NOA) patients. Low anti-Müllerian hormone (AMH) levels may predict success in idiopathic NOA cases.
Area of Science:
- Reproductive Medicine
- Urology
- Surgical Innovation
Background:
- Nonobstructive azoospermia (NOA) presents challenges in sperm retrieval.
- Microdissection testicular sperm extraction (mTESE) is a key technique for NOA.
- Minimizing testicular damage and optimizing surgical outcomes are crucial.
Purpose of the Study:
- To compare the efficacy and outcomes of stepwise mini-incision mTESE versus standard mTESE in NOA patients.
- To identify predictors of successful sperm retrieval in NOA.
- To evaluate the impact of different surgical approaches on operative time and invasiveness.
Main Methods:
- Retrospective analysis of 665 men undergoing stepwise mini-incision mTESE (Group 1) and 365 men undergoing standard mTESE (Group 2).
- Comparison of operation time, sperm retrieval rate (SRR), and surgical invasiveness.
- Multivariate logistic regression and ROC analysis to identify predictors of surgical outcomes, including anti-Müllerian hormone (AMH) levels.
Main Results:
- Stepwise mini-incision mTESE showed a significantly shorter operation time (64.0 ± 26.6 min) compared to standard mTESE (80.2 ± 31.3 min) (P <0.001).
- Overall SRR was comparable between the two groups (23.1%), with no significant difference regardless of NOA etiology.
- Preoperative AMH level was identified as a potential predictor for surgical outcomes in idiopathic NOA patients (OR: 0.57; 95% CI: 0.38-0.87; P =0.009).
Conclusions:
- Stepwise mini-incision mTESE is an effective and less invasive technique for NOA patients, offering reduced operative time with comparable sperm retrieval rates.
- Low AMH levels may indicate a higher likelihood of successful sperm retrieval in idiopathic NOA patients, even after initial failed attempts.
- This approach represents a valuable refinement in surgical sperm extraction for NOA management.
