Intraoperative assessment of tubules in predicting microdissection testicular sperm extraction outcome in men with Sertoli cell-only syndrome

Abstract

Objective: This study aimed to assess the value of measuring the tubule diameter during microdissection testicular sperm extraction (micro-TESE) in predicting outcomes in patients with Sertoli cell-only syndrome (SCOS).

Methods: Fifty-six consecutive patients with SCOS were included. Patients were classified into two groups on the basis of the diameter of seminiferous tubules measured against 5/0 surgical suture (≥100 µm or <100 µm).

Results: The sperm retrieval rate (SRR) in men with a tubule diameter ≥100 µm was significantly lower than that in those with <100 µm (3.1% vs. 25.0%). The SRR from the contralateral testis in men with a tubule diameter ≥100 µm was lower than that in those with <100 µm (0% vs. 14.3%). Men with a tubule diameter ≥100 µm had a significantly larger testis and lower follicle-stimulating hormone levels than did men with <100 µm (8.1 ± 2.4 vs. 5.3±1.8 mL, 19.9 ± 9.7 vs. 25.9 ± 7.1 mIU/mL, respectively).

Conclusions: The diameter of tubules is a useful predictor for a successful SRR in men with SCOS. Intraoperative assessment of homogeneous large tubules allows some men to perform a limited (superficial) contralateral micro-TESE after no spermatozoa are initially identified.

Keywords: Nonobstructive azoospermia; Sertoli cell-only syndrome; microdissection; microdissection testicular sperm extraction; seminiferous tubule diameter; sperm retrieval.

Figure 1.

Histopathology of (A) hypospermatogenesis, (B) maturation arrest, and (C) Sertoli cell-only syndrome.

Figure 2.

(A) Photograph showing seminiferous tubules that are larger in diameter than 5/0 surgical sutures (100 µm). (B) Photograph showing seminiferous tubules that are smaller than 5/0 surgical sutures.