Microdissection testicular sperm extraction in men with Sertoli cell only testicular histology

Capsule:
Diagnostic testis biopsy in nonobstructive azoospermia has little value, even when uniform Sertoli cell–only pattern is seen. When both testis volume and follicle-stimulating hormone are considered, sperm retrieval rates are 7%–45%.

Authors:
Boback M. Berookhim, M.D., M.B.A., Gianpiero D Palermo, M.D., Ph.D., Nikica Zaninovic, Ph.D., Zev Rosenwaks, M.D., Peter N. Schlegel, M.D.

Volume 102, Issue 5, Pages 1282-1286

Abstract:

Objective:
To study the outcomes of microdissection testicular sperm extraction (microTESE) among men with pure Sertoli cell–only histology on diagnostic testicular biopsy.

Design:
Retrospective cohort study.

Setting:
Tertiary referral center.

Patient(s):
Six hundred forty patients with pure Sertoli cell–only histology on testicular biopsy who underwent microTESE by a single surgeon.

Intervention(s):
MicroTESE.

Main Outcome Measure(s):
Sperm retrieval rates.

Result(s):
Overall, 44.5% of patients with Sertoli cell only had sperm retrieved with microTESE. No difference was noted in sperm retrieval rates based on testis volume (≥15 mL vs. <15 mL, 35.3% vs. 46.1%, respectively). Patients with ≥15 mL testicular volume and FSH 10–15 mU/mL had the worst prognosis, with a sperm retrieval rate of 6.7%. Conclusion(s):
Patients with previous testicular biopsy demonstrating Sertoli cell–only histology can be counseled that they have a reasonable likelihood of sperm retrieval with the contemporary delivery of microTESE. Given this finding, the utility of testicular biopsy before microTESE is further questioned.

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