Prospective comparative study between microsurgical and conventional testicular sperm extraction in nonobstructive azoospermia: follow-up by serial ultrasound examinations

The value of testicular sperm extraction (TESE) by microdissection was eval uated according to its physiological consequences compared with open, class ic surgical biopsy in the same patient. A total of 100 patients with nonobs tructive azoospermia and bilateral identical testicular histology underwent bilateral diagnostic TESE via the conventional method on one side and the microsurgical method on the other side. The spermatozoa recovery rate by mi crodissection TESE was significantly higher than by conventional TESE (47 a nd 30% respectively; P < 0.05). In order to assess the safety of this new p rocedure, 60 patients were followed-up ultrasonographically for 1, 3 and 6 months. Acute and chronic complications were significantly lower in the mic rosurgical side compared with the conventional side (15 and 58.3% respectiv ely and 3 and 30% respectively; P < 0.05). Segmental devascularization was detected in seven testes operated on conventionally, and in two testes oper ated on microsurgically, However, permanent devascularization could not be detected in any patient after 6 months. These findings suggest that microdi ssection TESE is not devoid of complications, but that it is relatively saf er than the conventional technique and improves sperm yield significantly i n patients with non-obstructive azoospermia.