A Comparative Study of Equatorial and Longitudinal Incision Techniques in Microdissection Sperm Extraction for...

Area of Science:

• Reproductive Medicine
• Urology
• Surgical Innovation

Background:

• Nonobstructive azoospermia (NOA) presents a significant challenge in male infertility.
• Microdissection testicular sperm extraction (micro-TESE) is a key technique for sperm retrieval in NOA patients.
• Different surgical approaches to micro-TESE may impact outcomes.

Purpose of the Study:

• To compare the efficacy and safety of equatorial versus longitudinal incisional micro-TESE.
• To evaluate sperm retrieval rates (SRR), postoperative pain, testicular volume, and testosterone levels.
• To determine the optimal micro-TESE approach for NOA patients.

Main Methods:

• Retrospective and prospective comparison of 50 NOA patients in each group (equatorial vs. longitudinal incisional micro-TESE).
• Data collected included operative time, pain scores (visual analog scale), complications, SRR, and hormonal profiles (FSH, LH, testosterone).
• Preoperative characteristics, SRR, testicular volume, and postoperative hormonal levels were compared between groups.

Main Results:

• Significantly higher SRR in the longitudinal group (62%) compared to the equatorial group (42%) (P=.045).
• No significant differences observed in operative time, pain scores, or postoperative complications.
• Testosterone levels decreased postoperatively in both groups, with no intergroup differences. Testicular volume also decreased similarly in both groups.

Conclusions:

• Longitudinal incisional micro-TESE significantly improves SRR in NOA patients compared to equatorial incisional micro-TESE.
• This approach does not increase complication rates, suggesting it is a safe alternative.
• Longitudinal incisional micro-TESE represents a potential advancement in surgical management for NOA.