Testicular Biopsy Histopathology as an Indicator of Successful Restoration of Spermatogenesis after Varicocelectomy in Non-obstructive Azoospermia

Abstract

Purpose: We aimed to evaluate the efficacy of using testicular biopsy histopathology as an indicator of the success of loupe-assisted subinguinal varicocelectomy in non-obstructive azoospermia (NOA) patients.

Materials and methods: In a 2-year period, a prospective study was carried at Minoufiya University Hospital on 20 NOA patients with clinical bilateral varicoceles. These patients underwent loupe-assisted subinguinal varicocelectomy with simultaneous testicular biopsy. All patients were evaluated by determining their hormonal profile and performing semen analyses and scrotal Doppler and transrectal ultrasonography. Two semen analyses showing azoospermia were performed before the surgery and two semen analyses were received at 3 and 6 months post-operatively for follow-up.

Results: The mean age was 29.9±6.7 years, and the mean follow-up duration was 17.3±8.3 months. We noted the restoration of spermatogenesis in six men (30% of all patients). Testicular biopsy results were as follows: hypospermatogenesis in 7 patients, maturation arrest in 3, and Sertoli cell-only syndrome in 10. The improvement in the sperm counts of these patients ranged from 3 million to 15 million/mL. Sperms were recovered in the hypospermatogenesis (6 patients, 85.5%) patients only, but other patients with testicular biopsy results of Sertoli cell-only or maturation arrest did not show any improvement in their semen parameters.

Conclusions: Testicular biopsy results showed that hypospermatogenesis patients have a better chance of improvement in their semen analysis after varicocelectomy in contrast to NOA patients with Sertoli cell-only syndrome or maturation arrest.

Keywords: Azoospermia; Histology; Testis; Varicocele.

Fig. 1

Hypospermatogenesis. Sections show reduced tubular and luminal diameters. There is an overall reduction in germ cell elements. Further, rare mature spermatids are seen. A high-power examination showed the presence of mature spermatids with dark nuclei (H&E, ×200).

Fig. 2

Case of spermatocytic arrest showed a halt of the maturation sequence, usually at the stage of the primary spermatocyte; no spermatids or spermatozoa were present (H&E, ×400).

Fig. 3

Tubules are populated by only Sertoli cells with a thickening of the tubular basement membrane; germ cells are completely absent (H&E, ×400).