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

Abstract

PurposeWe 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 MethodsIn 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.ResultsThe 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.ConclusionsTesticular 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.

The role of varicocele repair in non-obstructive azoospermic men: A systematic review

“…However, our systematic review included three further studies, and analysis was limited to the motile sperm in ejaculate to determine successful outcome of varicocele repair. These three studies showed that varicocele repair improved sperm count in non-obstructive azoospermic men [3,14,15]. Hypospermatogenesis and late maturation arrest pattern were associated with an optimal outcome of varicocele repair.…”

“…Open testicular biopsy was carried out on healthier testis based on size or consistency before or at the same time of varicocele repair. However, only two studies mentioned that varicocele repair and open testicular biopsy were performed by one surgeon only or together with a team [6,15]. This may result in differing opinions regarding the performance.…”

“…Some studies performed varicocele repair only for clinical varicocele [3,9,11,15]. The remaining studies performed varicocele repair for subclinical and clinical varicocele.…”

“…Twelve studies involving 261 men were included in the qualitative review [1,3,5,6,[8][9][10][11][12][13][14][15]. Among those studies, 6 studies were retrospective studies, 5 studies were prospective studies and one study was undefined.…”

“…The meta-analysis included eight studies that compared the quality of sperm count following varicocele surgery based on testicular histology [3,5,[8][9][10][11][12]15]. These studies comprised of 179 men.…”