Single tubule biopsy: a new objective microsurgical advancement for testicular sperm retrieval in patients with nonobstructive azoospermia

Amer, Medhat; Zohdy, Wael; Naser, Taha Abd El; Hosny, Hossam; Arafa, Mohamed; Fakhry, Emad

doi:10.1016/j.fertnstert.2007.03.043

Cited by 22 publications

(17 citation statements)

References 34 publications

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“…The results of the present study confirm that the seminiferous tubule caliber pattern as found at high magnification during microTESE is predictive of sperm retrieval in patients with NOA. This finding, being already anticipated by previous studies (Schlegel, ; Okada et al ., ; Tsujimura et al ., ; Amer et al ., ), is now fully supported by the diagnostic accuracy measures provided by the present study.…”

Section: Discussionsupporting

confidence: 80%

“…Three years later, Okada and coworkers (Okada et al ., ) evaluated 74 patients with NOA undergoing microTESE and found dilated tubules in 20 of 33 patients with SSR (60%), while Tsujimura (Tsujimura et al ., ) evaluated 56 patients with NOA and found homogeneous dilated tubules in seven, all of them with SSR (100%), 23 patients with homogeneous non‐dilated tubules, all with failed sperm retrieval, and 26 with heterogeneous tubule thickness (the pattern of seminiferous tubules retrieved was not specified), 17 (65%) of whom had SSR. Amer and colleagues (Amer et al ., ) provided a measure of tubule caliber using a micrometer fixed to the eyepiece of the operating microscope. They reported that sperm retrieval rate was significantly higher in cases with tubule diameter >150 μm (SSR 49.2% vs. 31.4% respectively), reaching 84.2% when tubule diameter exceeded 300 μm.…”

Section: Discussionmentioning

confidence: 99%

“…Among the potential factors able to explain the outcome of microTESE in individual NOA subjects, the evaluation of the prevalent seminiferous tubule caliber pattern found at high magnification has attracted the attention of few authors in the past decade (Okada et al ., ; Tsujimura et al ., ; Amer et al ., ), but none provided an evaluation of its diagnostic accuracy in predicting the sperm retrieval success in NOA patients.…”

Section: Introductionmentioning

confidence: 99%

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The seminiferous tubule caliber pattern as evaluated at high magnification during microdissection testicular sperm extraction predicts sperm retrieval in patients with non‐obstructive azoospermia

Caroppo¹,

Colpi

Gazzano

et al. 2018

Andrology

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Background: microTESE proved to be the gold standard surgical approach for patients with non-obstructive azoospermia (NOA), but sperm retrieval rates (SRRs) vary considerably among centers. Some authors compared their SRRs with the pattern of seminiferous tubule caliber found at high magnification, but none provided diagnostic accuracy measures. Objective: The present retrospective study sought to verify the diagnostic accuracy of the pattern of seminiferous tubule caliber in predicting the sperm retrieval in NOA patients. Materials and Methods: Data from 143 infertile NOA men undergoing unilateral (64) or bilateral (79) microTESE (222 testes) were retrospectively evaluated. During microTESE, if present, dilated tubules (DTs) were retrieved, otherwise tubules with slightly larger caliber (SDT) (924) than that of the surroundings were removed. When no DT or SDT were found, not dilated tubules (NDTs) were excised. Results: Spermatozoa were retrieved in 95 of 222 testes (42.8%); sperm retrieval was successful in 90% of testes with DTs, in 47% of those with SDTs, and only in 7% of those with NDTs (p < 0.0001). Stepwise binary logistic regression revealed that the combination of seminiferous tubule pattern and testis histology was significantly predictive of SSR, being able to classify 86.8% of testes, with an excellent diagnostic accuracy (AUC 0.93). The median number of spermatozoa retrieved was significantly higher in DTs compared with SDTs and NDTs. Discussion: The results of the present study provide reliable accuracy measures in support of the relationship between seminiferous tubule caliber pattern and SSR in patients with non-obstructive azoospermia. We are proposing for the first time that spermatozoa may be retrieved even from slightly dilated tubules in about half of cases. The pattern of tubules retrieved, together with histology, may represent an additional outcome measure of microTESE. Conclusion: The pattern of seminiferous tubules together with testis histology predicts sperm retrieval with an excellent diagnostic accuracy. SUPPORTING INFORMATIONAdditional supporting information may be found online in the Supporting Information section at the end of the article.Table S1 Clinical parameters as stratified per tubules caliber pattern.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The seminiferous tubule caliber pattern as evaluated at high magnification during microdissection testicular sperm extraction predicts sperm retrieval in patients with non‐obstructive azoospermia

Caroppo¹,

Colpi

Gazzano

et al. 2018

Andrology

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“…A routine treatment for nonobstructive azoospermia is microdissection testicular sperm extraction (micro-TESE), wherein larger, more opaque seminiferous tubules are selectively removed (4). These tubules are more likely to contain developing germ cells rather than only Sertoli cells (5).…”

mentioning

confidence: 99%

Role of tissue digestion and extensive sperm search after microdissection testicular sperm extraction

Ramasamy

Reifsnyder

Bryson

et al. 2011

Fertility and Sterility

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“…Once the Area-Ratio metric is calculated based on the size of the smaller tubule diameter and compared with the experimentally measured data, the surgeon can discern whether or not the present location is a region of interest. By using the above metric tubule diameters can be estimated within a size sensitivity of 50 µm, which is well suited for microdissection-TESE surgery where the difference between smaller infertile and larger fertile tubule diameters is known to be above 100 µm [10].…”

Section: B Area-ratio Metricmentioning

confidence: 99%

Ultrasonically actuated silicon-microprobe-based testicular tubule metrology

Ramkumar

Lal

Paduch

2010

2010 Annual International Conference of the IEEE Engineering in Medicine and Biology

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We report on a microfabricated silicon microprobe integrated with an ultrasonic actuator and polysilicon strain gauges for Microdissection Testicular Sperm Extraction (TESE) surgery. Multiple microprobe insertion experiments were performed on rat testis tissue and, by monitoring the tubule puncture artifacts in the force signal sensed by the microprobe, we were able to estimate the average diameter of the sperm-carrying tubules in the sample. We have demonstrated the ability to sense the existence of larger tubules embedded in a mass of thinner tubules, by means of an Area-Ratio based metric using an analytically calculated expression for the distribution of sizes measured by the microprobe. This information is important in microdissection TESE to distinguish tubules with and without fertile sperm, potentially eliminating the large incision currently required for optical spermatazoa localization.

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Single tubule biopsy: a new objective microsurgical advancement for testicular sperm retrieval in patients with nonobstructive azoospermia

Cited by 22 publications

References 34 publications

The seminiferous tubule caliber pattern as evaluated at high magnification during microdissection testicular sperm extraction predicts sperm retrieval in patients with non‐obstructive azoospermia

The seminiferous tubule caliber pattern as evaluated at high magnification during microdissection testicular sperm extraction predicts sperm retrieval in patients with non‐obstructive azoospermia

Role of tissue digestion and extensive sperm search after microdissection testicular sperm extraction

Ultrasonically actuated silicon-microprobe-based testicular tubule metrology

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