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Relevance of testicular histopathology on prediction of sperm retrieval rates after a conventional bilateral multiple TESE in case of non-obstructive azoospermia (NOA) and obstructive-azoospermia (OA)

Cito, G1; Coccia, ME1; Dabizzi, S1; Picone, R1; Morselli, S1; Della Camera, PA1; Cocci , A1; Criscuoli, L1; Nesi , G1; Micelli, E2; Gacci, M1; Serni, S1; Carini, M1; Natali, A1

1: Careggi Hospital, Florence, Italy; 2: St Clare's Hospital, Pisa, Italy

 

 

Objective: To establish the relevance of testicular histopathology (TH) on sperm retrieval (SR) after testicular sperm extraction (TESE) in patients with non-obstructive azoospermia (NOA) and in obstructive azoospermia (OA) patients, already underwent a previous failure testicular fine needle aspiration (TEFNA).

Materials and Methods: We evaluated a total of 82 azoospermic men, underwent TESE, referring to our Centre between January 2008 and March 2017. A general and genital physical examination, scrotal and trans-rectal ultrasound, semen analysis, hormone measurements, including follicle stimulating hormone (FSH), luteinizing hormone (LH) and total testosterone (TT) were collected.

Results: Successful sperm retrieval (SSR) was obtained in 36 men of total (43.9%).(Table 1) SSR was 29.5% in NOA patients, while OA men, underwent a previous failure TEFNA, had SR in 86% of cases. Mean LH was 6.55 IU/L, TT 4.70 ng/ml, testicular volume (TV) right 13.7 ml and TV left 13.6 ml. FSH mean was 13.45 IU/L in patients with negative SR and 8.18 IU/L in men with SSR. According to histology, 20.7% had Normal Spermatogenesis (NS), 35.3% Hypospermatogenesis (H), 35.3% Maturation Arrest (MA) and 8.5% Sertoli-Cell-Only-Syndrome (SCOS). SSR was 88.2% in patients with NS, 24.1% in the MA group and 48.27% in patients with Hypospermatogenesis, while negative SR was reported in SCOS patients. 2 patients with NS and unsuccessful SR, underwent a second TESE, of whom one had SR and cryopreservation.

Conclusion: Testicular histopathology after TESE offers important information on prediction of SR and can guide the surgeon in choosing the more suitable therapeutic practice.

Table 1: Comparison of clinical parameters, hormonal plasma concentrations parameters and testicular volume with sperm retrieval in azoospermic patients after TESE.

Parameter

Positive sperm retrieval

Negative sperm retrieval

p value

Patients n (%)

36 (43.9%)

46 (56.0%)

Age mean years (SD)

37.8 (+/-5.7)

37.5 (+/-5.7)

  0.79

BMI mean (SD)

22.3 (+/-3.1)

23.2 (+/-3.8)

  0.28

FSH mean IU/L (SD)

8.18 (+/-9.45)

13.4 (+/-7.11)

< 0.005

LH mean IU/L (SD)

5.65 (+/-5.2)

7.25 (+/-5.44)

  0.18

TT mean ml (SD)

4.57 (+/-1.57)

4.86 (+/-1.79)

  0.43

TV right mean ml (SD)

15.7 (+/-4.92)

12.1 (+/-4.62)

< 0.005

TV left mean ml (SD)

15.3 (+/-5.82)

11.9 (+/-4.65)

< 0.005

Disclosure:

Work supported by industry: no.

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