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. 2013 Nov;15(6):795-8.
doi: 10.1038/aja.2013.98. Epub 2013 Sep 9.

No relationship between biopsy sites near the main testicular vessels or rete testis and successful sperm retrieval using conventional or microdissection biopsies in 220 non-obstructive azoospermic men

J Ullrich Schwarzer  1 , Heiko Steinfatt, Manfred Schleyer, Frank M Köhn, Klaus Fiedler, Irene von Hertwig, Gottfried Krüsmann, Wolfgang Würfel
Affiliations

No relationship between biopsy sites near the main testicular vessels or rete testis and successful sperm retrieval using conventional or microdissection biopsies in 220 non-obstructive azoospermic men

J Ullrich Schwarzer et al. Asian J Androl. 2013 Nov.

Abstract

In 220 consecutive patients with non-obstructive azoospermia, sperm retrieval was attempted by a combination of conventional and microdissection testicular sperm extraction (TESE). For sperm retrieval, 2-3 conventional biopsies were performed followed by a microdissection TESE in cases of negative conventional biopsies. During the surgery, the vasculature of the testis was assessed using the operative microscope, and the location of positive biopsies was registered in relation to the blood supply. The overall sperm retrieval rate was 58.2%. From the initial conventional biopsies, sperm could be retrieved in 46.8% of the patients. With microdissection TESE, sperm could be retrieved from an additional 11.4% of the patients. The further use of microdissection TESE improved the sperm retrieval rate significantly (P=0.017). No significant accumulation of positive biopsies was found towards the rete testis or the main testicular vessels.

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Figures

Figure 1
Figure 1
Location of testicular biopsies in relation to the main blood supply. (a) is location next to the rete testis; (b) is location next to the main branches of the testicular vessels; (c) is location distant from the main branches of the testicular vessels.
Figure 2
Figure 2
(a) Dilated and opaque seminiferous tubule suggesting a focal area of spermatogenesis; (b) intraoperative view of the divided testicular lobes using a vessel-sparing microsurgical technique: b1 is location next to the rete testis, b2 is location next to the main branches of testicular vessels and b3 is location distant from the main branches of the testicular vessels.
Figure 3
Figure 3
Distribution of sperm-positive areas in relation to the central testicular blood supply. (a) Initial conventional TESE combined with M-TESE; (b) distribution of sperm foci that were detected exclusively by microdissection TESE. M-TESE, microdissection testicular sperm extraction; TESE, testicular sperm extraction.
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