Clinical comparison between conventional and microdissection testicular sperm extraction for non-obstructive azoospermia: Understanding which treatment works for which patient

  • Elia Maglia IRCCS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Department of Urology, Milan, Italy.
  • Luca Boeri | dr.lucaboeri@gmail.com IRCCS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Department of Urology, Milan, Italy.
  • Matteo Fontana IRCCS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Department of Urology, Milan, Italy.
  • Andrea Gallioli IRCCS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Department of Urology, Milan, Italy.
  • Elisa De Lorenzis IRCCS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Department of Urology, Milan, Italy.
  • Franco Palmisano IRCCS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Department of Urology, Milan, Italy.
  • Stefano Zanetti IRCCS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Department of Urology, Milan, Italy.
  • Gianluca Sampogna IRCCS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Department of Urology, Milan, Italy.
  • Liliana Restelli IRCCS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Department of Urology, Milan, Italy.
  • Edgardo Somigliana IRCCS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Department of Urology, Milan, Italy.
  • Mariapia Serrago IRCCS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Department of Urology, Milan, Italy.
  • Franco Gadda IRCCS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Department of Urology, Milan, Italy.
  • Emanuele Montanari IRCCS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Department of Urology, Milan, Italy.

Abstract

Objectives: The superiority of microdissection testicular sperm extraction (mTESE) over conventional TESE (cTESE) for men with non-obstructive azoospermia (NOA) is debated. We aimed to compare the sperm retrieval rate (SRR) of mTESE to cTESE and to identify candidates who would most benefit from mTESE in a cohort of Caucasian-European men with primary couple’s infertility.
Material and methods: Data from 49 mTESE and 96 cTESE patients were analysed. We collected demographic and clinical data, serum levels of LH, FSH and total testosterone. Patients with abnormal karyotyping were excluded from analysis. Age was categorized according to the median value of 35 years. FSH values were dichotomized according to multiples of the normal range (N) (N and 1.5 N: 1-18 mIU/mL, and > 18 mIU/mL). Testicular histology was recorded for each patient. Descriptive statistics and logistic regression analyses tested the impact of potential predictors on positive SRR in both groups.
Results: No differences were found between groups in terms of clinical and hormonal parameters with the exception of FSH values that were higher in mTESE patients (p = 0.004). SRR were comparable between mTESE and cTESE (49.0% vs. 41.7%, p = 0.40). SRRs were significantly higher after mTESE in patients with Sertoli cell-only syndrome (SCOS) (p = 0.038), in those older than 35 years (p = 0.03) and with FSH >1.5N (p < 0.001), as compared to men submitted to cTESE. Multivariable logistic regression analysis showed that mTESE was independent predictor of positive SR in patients older than 35 years (p = 0.002) and with FSH > 1.5N (p = 0.018). Moreover, increased FSH levels (p = 0.03) and both SCOS (p = 0.01) and MA histology (p = 0.04) were independent predictors of SRR failure.
Conclusions: Microdissection and cTESE showed comparable success rates in our cohort of patients with NOA. mTESE seems beneficial for patients older than 35 years, with high FSH values, or when SCOS can be predicted. Given the high costs associated with the mTESE approach, the identification of candidates most likely to benefit from this procedure is a major clinical need.

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Published
2018-06-30
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Section
Original Papers - Andrology
Keywords:
testicular sperm extraction, non-obstructive azoospermia, infertility, risk factors
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How to Cite
Maglia, E., Boeri, L., Fontana, M., Gallioli, A., De Lorenzis, E., Palmisano, F., Zanetti, S., Sampogna, G., Restelli, L., Somigliana, E., Serrago, M., Gadda, F., & Montanari, E. (2018). Clinical comparison between conventional and microdissection testicular sperm extraction for non-obstructive azoospermia: Understanding which treatment works for which patient. Archivio Italiano Di Urologia E Andrologia, 90(2), 130-135. https://doi.org/10.4081/aiua.2018.2.130