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Sensitivity, Specificity and Accuracy of Intraoperative Findings in Microdissection Testicular Sperm Extraction: A Prospective Study

Sensitivity, Specificity and Accuracy of Intraoperative Findings in Microdissection Testicular... Background: Identification of healthy looking testicular tissue is the rationale behind successful microdissection testicular sperm extraction (TESE). Objective: To determine sensitivity, specificity and accuracy of intraoperative microscopic findings during microdissection TESE as correlated to successful sperm retrieval. Patients and Methods: A consecutive 100 primary infertile men with non-obstructive azoospermia were prospectively enrolled for microdissection TESE in a single tertiary academic center. Under anesthesia, testicular parenchyma was examined at high magnification to identify dilated, opaque or whitish tubules which are considered to contain spermatozoa. Additionally 2 samples were taken from the adjacent tissues of non-dilated tubules for sperm retrieval and histological examination. If no dilated tubules were observed, multiple samples were randomly excised from middle and polar areas. Results: The mean age was 36.4 ± 8.4 years and the mean duration of infertility was 9.1 ± 7.2 years. Both testes were explored in 68 patients and one was examined in 32. Microdissection TESE retrieved mature spermatozoa in 33 patients (33%). A total of 168 testes were examined and the foci of healthy looking testicular tissue were identified in 44 (26.2%). A false positive result (dilated tubules with no sperms retrieved) was encountered in 10 cases. A false negative result (no dilated tubules were identified in spite of retrieval of mature sperms) was found in 3 cases. The over all sensitivity, specificity and accuracy of the examined testes were 91.9, 92.4 and 92.3 %, respectively. Hypospermatogenesis had the highest sperm retrieval rate. Sperm retrieval rate was not related to serum follicle-stimulating hormone, testosterone or previous sperm retrieval interventions but to the most advanced pattern of testicular histology (p = 0.027). Conclusion: Identification of healthy looking testicular tissue during microdissection TESE is highly sensitive, specific and accurate for successful sperm retrieval. Our results prove the rationale behind the procedure. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Current Urology Karger

Sensitivity, Specificity and Accuracy of Intraoperative Findings in Microdissection Testicular Sperm Extraction: A Prospective Study

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Publisher
Karger
Copyright
© 2008 S. Karger AG, Basel
ISSN
1661-7649
eISSN
1661-7657
DOI
10.1159/000189653
Publisher site
See Article on Publisher Site

Abstract

Background: Identification of healthy looking testicular tissue is the rationale behind successful microdissection testicular sperm extraction (TESE). Objective: To determine sensitivity, specificity and accuracy of intraoperative microscopic findings during microdissection TESE as correlated to successful sperm retrieval. Patients and Methods: A consecutive 100 primary infertile men with non-obstructive azoospermia were prospectively enrolled for microdissection TESE in a single tertiary academic center. Under anesthesia, testicular parenchyma was examined at high magnification to identify dilated, opaque or whitish tubules which are considered to contain spermatozoa. Additionally 2 samples were taken from the adjacent tissues of non-dilated tubules for sperm retrieval and histological examination. If no dilated tubules were observed, multiple samples were randomly excised from middle and polar areas. Results: The mean age was 36.4 ± 8.4 years and the mean duration of infertility was 9.1 ± 7.2 years. Both testes were explored in 68 patients and one was examined in 32. Microdissection TESE retrieved mature spermatozoa in 33 patients (33%). A total of 168 testes were examined and the foci of healthy looking testicular tissue were identified in 44 (26.2%). A false positive result (dilated tubules with no sperms retrieved) was encountered in 10 cases. A false negative result (no dilated tubules were identified in spite of retrieval of mature sperms) was found in 3 cases. The over all sensitivity, specificity and accuracy of the examined testes were 91.9, 92.4 and 92.3 %, respectively. Hypospermatogenesis had the highest sperm retrieval rate. Sperm retrieval rate was not related to serum follicle-stimulating hormone, testosterone or previous sperm retrieval interventions but to the most advanced pattern of testicular histology (p = 0.027). Conclusion: Identification of healthy looking testicular tissue during microdissection TESE is highly sensitive, specific and accurate for successful sperm retrieval. Our results prove the rationale behind the procedure.

Journal

Current UrologyKarger

Published: Jan 1, 2009

Keywords: Azoospermia; Infertility; Spermatogenesis; Microdissection testicular sperm extraction

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