Study: Deeper mTESE incision yields dividends

When the initial wide incision of a microdissection testicular sperm extraction procedure reveals no sperm-containing tubules, there is a 35% chance of finding sperm with a deeper, more extensive exploration, according to a 10-year study of 900 men with nonobstructive azoospermia.

The study, conducted by researchers from Weill Cornell Medical College, New York, also found that there is a 7% chance of finding sperm in the contralateral testis when exploration of the initial, usually larger, testis is negative.

"A number of the urologists who do this procedure may stop when no sperm is found following initial wide incision," first author Ranjith Ramasamy, MD, told Urology Times. Many surgeons stop because the more extensive procedure is challenging and because they feel that negative results on the initial procedure portend negative results on the more extensive procedure, added Dr. Ramasamy, who worked on the study with Peter Schlegel, MD, and colleagues.

Of the 900 men with nonobstructive azoospermia in the study, surgeons and embryologists were able to identify sperm in 474 (52.6%) during the first microdissection and retrieve sperm from 245 of these men during the initial wide incision. This latter number is 27.2% of the total cohort. Of the 374 men overall who had successful sperm retrieval, 245 (65%) had sperm identified during the initial wide incision. More extensive dissection found sperm in the remainder this cohort. Some 566 men (62.8% of the total) underwent bilateral microdissection and 40 (7%) of these men presented with sperm on the contralateral side.

The findings provide valuable information for both patients and urologists, says Dr. Ramasamy. Both should now understand that the more extensive procedure holds promise. Dr. Ramasamy noted that in his experience, the vast majority of men, when properly counseled, are willing to undergo the more extensive experience in order to father children.

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