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Outcomes and predictive factors of successful salvage microdissection testicular sperm extraction (mTESE) after failed classic TESE: results from a multicenter cross-sectional study

International Journal of Impotence Research volume 34, pages 795–799 (2022)Cite this article

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Abstract

Microdissection testicular sperm extraction (mTESE) has been proposed as a salvage treatment option for men with a previously failed classic TESE (cTESE), but data are scarce. We aimed to assess the outcome of and potential predictors of successful salvage mTESE in a cohort of men previously submitted to unfruitful cTESE. Data from 61 men who underwent mTESE after a failed cTESE between 01/2014 and 10/2020, at 6 tertiary-referral centres in Italy were analysed. All men were investigated with semen analyses, testicular ultrasound, hormonal and genetic blood testing. Pathological diagnosis from TESE was collected in every man. Descriptive statistics and logistic regression models were used to investigate potential predictors of positive sperm retrieval (SR+) after salvage mTESE. Baseline serum Follicle-Stimulating hormone (FSH) and total testosterone levels were 17.2 (8.6–30.1) mUI/mL and 4.7 (3.5-6.4) ng/mL, respectively. Sertoli-cell-only syndrome (SCOS), maturation arrest (MA) and hypospermatogenesis were found in 24 (39.3%), 21 (34.4%) and 16 (26.2%) men after cTESE, respectively. At mTESE, SR+ was found in 30 (49.2%) men. Patients with a diagnosis of hypospermatogenesis had a higher rate of SR+ (12/16 (75%)) compared to MA (12/21 (57.1%)) and SCOS (6/24 (25%)) patients at mTESE (p < 0.01). No clinical and laboratory differences were observed between SR+ and SR- patients at mTESE. There were no significant complications after mTESE. At multivariable logistic regression analysis, only hypospermatogenesis (OR 9.5; p < 0.01) was independently associated with SR+ at mTESE, after accounting for age and FSH.

In conclusion, salvage mTESE in NOA men with previous negative cTESE was safe and promoted SR+ in almost 50%. A baseline pathology of hypospermatogenesis at cTESE emerged as the only independent predictor of positive outcomes at salvage mTESE.

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References

  1. Cooper TG, Noonan E, von Eckardstein S, Auger J, Baker HWG, Behre HM, et al. World Health Organization reference values for human semen characteristics. Hum Reprod Update. 2010;16:231–45.

    Article  Google Scholar 

  2. Cocuzza M, Alvarenga C, Pagani R. The epidemiology and etiology of azoospermia. Clin (Sao Paulo). 2013;68:15–26. Suppl 1.

    Article  Google Scholar 

  3. Minhas S, Bettocchi C, Boeri L, Capogrosso P, Carvalho J, Cilesiz NC, et al. European Association of Urology Guidelines on Male Sexual and Reproductive Health: 2021 update on male infertility. Eur Urol. 2021;S0302-2838:01982–5.

    Google Scholar 

  4. Bernie AM, Mata DA, Ramasamy R, Schlegel PN. Comparison of microdissection testicular sperm extraction, conventional testicular sperm extraction, and testicular sperm aspiration for nonobstructive azoospermia: a systematic review and meta-analysis. Fertil Steril. 2015;104:1099–1103.e1-3.

    Article  Google Scholar 

  5. Corona G, Minhas S, Giwercman A, Bettocchi C, Dinkelman-Smit M, Dohle G, et al. Sperm recovery and ICSI outcomes in men with non-obstructive azoospermia: a systematic review and meta-analysis. Hum Reprod Update. 2019;25:733–57.

    Article  Google Scholar 

  6. Maglia E, Boeri L, Fontana M, Gallioli A, De Lorenzis E, Palmisano F, et al. Clinical comparison between conventional and microdissection testicular sperm extraction for non-obstructive azoospermia: Understanding which treatment works for which patient. Arch Ital Urol Androl. 2018;90:130–5.

    Article  CAS  Google Scholar 

  7. Deruyver Y, Vanderschueren D, Van der Aa F. Outcome of microdissection TESE compared with conventional TESE in non-obstructive azoospermia: a systematic review. Andrology. 2014;2:20–4.

    Article  CAS  Google Scholar 

  8. Tsujimura A, Miyagawa Y, Takao T, Takada S, Koga M, Takeyama M, et al. Salvage microdissection testicular sperm extraction after failed conventional testicular sperm extraction in patients with nonobstructive azoospermia. J Urol. 2006;175:1446–9. discussion 1449.

    Article  Google Scholar 

  9. Kalsi JS, Shah P, Thum Y, Muneer A, Ralph DJ, Minhas S. Salvage micro-dissection testicular sperm extraction; outcome in men with non-obstructive azoospermia with previous failed sperm retrievals. BJU Int. 2015;116:460–5.

    Article  CAS  Google Scholar 

  10. Xu T, Peng L, Lin X, Li J, Xu W Predictors for successful sperm retrieval of salvage microdissection testicular sperm extraction (TESE) following failed TESE in nonobstructive azoospermia patients. Andrologia. 2017;49.

  11. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.

    Article  CAS  Google Scholar 

  12. Boeri L, Capogrosso P, Ventimiglia E, Cazzaniga W, Pozzi E, Belladelli F, et al. Testicular volume in infertile versus fertile white-European men: a case-control investigation in the real-life setting. Asian J Androl. 2021;23:501–9.

    Article  Google Scholar 

  13. Ventimiglia E, Capogrosso P, Boeri L, Pederzoli F, Cazzaniga W, Scano R, et al. When to perform karyotype analysis in infertile men? validation of the European Association of urology guidelines with the proposal of a new predictive model. Eur Urol. 2016;70:920–3.

    Article  Google Scholar 

  14. Amer M, Haggar SE, Moustafa T, Abd El-Naser T, Zohdy W. Testicular sperm extraction: impact of testicular histology on outcome, number of biopsies to be performed and optimal time for repetition. Hum Reprod. 1999;14:3030–4.

    Article  CAS  Google Scholar 

  15. Schlegel PN, Su LM. Physiological consequences of testicular sperm extraction. Hum Reprod. 1997;12:1688–92.

    Article  CAS  Google Scholar 

  16. Schlegel PN. Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision. Hum Reprod. 1999;14:131–5.

    Article  CAS  Google Scholar 

  17. Akbal C, Mangir N, Tavukçu HH, Ozgür O, Simşek F. Effect of testicular sperm extraction outcome on sexual function in patients with male factor infertility. Urology. 2010;75:598–601.

    Article  Google Scholar 

  18. Yücel C, Budak S, Keskin MZ, Kisa E, Kozacioglu Z. Predictive factors of successful salvage microdissection testicular sperm extraction (mTESE) after failed mTESE in patients with non-obstructive azoospermia: Long-term experience at a single institute. Arch Ital Urol Androl. 2018;90:136–40.

    Article  Google Scholar 

  19. Abdel Raheem A, Garaffa G, Rushwan N, De Luca F, Zacharakis E, Abdel Raheem T, et al. Testicular histopathology as a predictor of a positive sperm retrieval in men with non-obstructive azoospermia. BJU Int. 2013;111:492–9.

    Article  Google Scholar 

  20. Caroppo E, Colpi EM, Gazzano G, Vaccalluzzo L, Scroppo FI, D’Amato G, et al. Testicular histology may predict the successful sperm retrieval in patients with non-obstructive azoospermia undergoing conventional TESE: a diagnostic accuracy study. J Assist Reprod Genet. 2017;34:149–54.

    Article  Google Scholar 

  21. Kalsi J, Thum M-Y, Muneer A, Abdullah H, Minhas S. In the era of micro-dissection sperm retrieval (m-TESE) is an isolated testicular biopsy necessary in the management of men with non-obstructive azoospermia? BJU Int. 2012;109:418–24.

    Article  Google Scholar 

  22. Özman O, Tosun S, Bayazıt N, Cengiz S, Bakırcıoğlu ME. Efficacy of the second micro-testicular sperm extraction after failed first micro-testicular sperm extraction in men with nonobstructive azoospermia. Fertil Steril. 2021;115:915–21.

    Article  Google Scholar 

  23. Boeri L, Palmisano F, Preto M, Sibona M, Capogrosso P, Franceschelli A, et al. Sperm retrieval rates in non-mosaic Klinefelter patients undergoing testicular sperm extraction: What expectations do we have in the real-life setting? Andrology. 2020;8:680–7.

    Article  CAS  Google Scholar 

  24. Pozzi E, Boeri L, Capogrosso P, Palmisano F, Preto M, Sibona M, et al. Rates of hypogonadism forms in Klinefelter patients undergoing testicular sperm extraction: A multicenter cross-sectional study. Andrology. 2020;8:1705–11.

    Article  CAS  Google Scholar 

  25. Ernandez J, Berk B, Han T, Abou Ghayda R, Kathrins M. Evaluating the quality of reported outcomes for microsurgical TESE in men with non-obstructive azoospermia: A methodological analysis. Andrology. 2021;9:1108–18.

    Article  Google Scholar 

Download references

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Authors and Affiliations

  1. Department of Urology, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy

    Luca Boeri, Carolina Bebi, Matteo Turetti, Franco Gadda & Emanuele Montanari

  2. Unit of Robotic & Mininvasive Surgery - Casa Di Cura Villa Igea, Ancona, Italy

    Donato Dente

  3. Centre for Reproductive Medicine, European Hospital, Rome, Italy

    Ermanno Greco

  4. Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, Naples, Italy

    Marco Capece & Alessandro Palmieri

  5. Department of Urology and Andrology Surgery, University of Florence, Florence, Italy

    Andrea Cocci & Gianmartin Cito

  6. Division of Urology, A.O.U. Città della Salute e della Scienza di Torino - Presidio Molinette, Turin, Italy

    Mirko Preto, Marco Falcone, Carlo Ceruti, Luigi Rolle & Paolo Gontero

  7. Reproductive Medicine Unit, GynePro Medical Centers, NextClinics International, Bologna, Italy

    Edoardo Pescatori & Walter Ciampaglia

  8. Department of Urology and Andrology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy

    Fabrizio Ildefonso Scroppo & Federico Dehò

  9. Department Gynaecological-Obstetrical and Urological Sciences, Sapienza University of Rome, Rome, Italy

    Giorgio Franco

  10. Vita-Salute San Raffaele University, Milan, Italy

    Francesco Montorsi & Andrea Salonia

  11. Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy

    Francesco Montorsi & Andrea Salonia

Authors
  1. Luca Boeri
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  2. Carolina Bebi
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  3. Donato Dente
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  5. Matteo Turetti
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  6. Marco Capece
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  7. Andrea Cocci
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  9. Mirko Preto
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  10. Edoardo Pescatori
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  11. Walter Ciampaglia
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  12. Fabrizio Ildefonso Scroppo
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  13. Marco Falcone
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  14. Carlo Ceruti
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  15. Franco Gadda
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  18. Alessandro Palmieri
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  22. Emanuele Montanari
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Contributions

LB was responsible for designing the protocol, collecting data, interpreting results, performing statistical analysis and drafting the manuscript. CB was responsible for collecting data, interpreting results. DD was responsible for collecting data, interpreting results. EG was responsible for collecting data, interpreting results. MT was responsible for collecting data, interpreting results. MC was responsible for collecting data, interpreting results. AC was responsible for collecting data, interpreting results. GC was responsible for collecting data, interpreting results. MP was responsible for collecting data, interpreting results. EP was responsible for collecting data, interpreting results. WC was responsible for collecting data, interpreting results. FS was responsible for collecting data, interpreting results. MF was responsible for collecting data, interpreting results. CC was responsible for collecting data, interpreting results. FG was responsible for collecting data, interpreting results. GF was responsible for collecting data, interpreting results. FD was responsible for collecting data, interpreting results, supervising the study. AP was responsible for collecting data, interpreting results, supervising the study. LR was responsible for collecting data, interpreting results, supervising the study. PG was responsible for collecting data, interpreting results, supervising the study. FM was responsible for collecting data, interpreting results, supervising the study. EM was responsible for collecting data, interpreting results, supervising the study. AS was responsible for collecting data, interpreting results, supervising the study.

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Correspondence to Luca Boeri.

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Boeri, L., Bebi, C., Dente, D. et al. Outcomes and predictive factors of successful salvage microdissection testicular sperm extraction (mTESE) after failed classic TESE: results from a multicenter cross-sectional study. Int J Impot Res 34, 795–799 (2022). https://doi.org/10.1038/s41443-021-00487-8

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