Quantifying Heterogeneity of Testicular Histopathology in Men with Nonobstructive Azoospermia

No AccessJournal of UrologyAdult Urology1 Nov 2021Quantifying Heterogeneity of Testicular Histopathology in Men with Nonobstructive AzoospermiaThis article is commented on by the following:Editorial Comment Nahid Punjani, Ryan Flannigan, Caroline Kang, Francesca Khani, and Peter N. Schlegel Nahid PunjaniNahid Punjani Department of Urology, Weill Cornell Medical College, New York, New York Supported in part by the Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust. More articles by this author , Ryan FlanniganRyan Flannigan Department of Urology, Weill Cornell Medical College, New York, New York Supported by Vancouver Coastal Health Research Institute. More articles by this author , Caroline KangCaroline Kang Department of Urology, Weill Cornell Medical College, New York, New York Supported in part by the Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust. More articles by this author , Francesca KhaniFrancesca Khani Department of Urology, Weill Cornell Medical College, New York, New York Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York More articles by this author , and Peter N. SchlegelPeter N. Schlegel ‡Correspondence: New York Presbyterian/Weill Cornell Medicine, 525 E. 68th St., Starr 900, New York, New York 10065 telephone: 212-746-5491; FAX: 212-746-8425; E-mail Address: [email protected] Department of Urology, Weill Cornell Medical College, New York, New York More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001951AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We sought to determine if testicular histopathological heterogeneity is associated with sperm retrieval rates (SRRs) in men with nonobstructive azoospermia (NOA) who are undergoing microdissection testicular sperm extraction (mTESE). Materials and Methods: All patients undergoing mTESE by a single, high-volume surgeon at a tertiary infertility referral center between 2010 and 2020 were evaluated. Pathology reports from testis biopsy at the time of mTESE reported by fellowship-trained genitourinary pathologists were reviewed. Testicular heterogeneity was correlated to absolute SRRs. Logistic regression was used to determine if heterogeneity was associated with sperm retrieval. Results: A total of 918 men with mTESE were included. Of these, 391 men (43%) had 1 pathology, 388 men (42%) had 2, 108 (12%) had 3, and 31 (3.4%) had 4. Overall, the most common histopathology was Sertoli-cell only, followed by maturation arrest. The overall SRR was 42% with a clinical intrauterine gestation rate of 30%. Increasing histopathological variety was associated with higher SRRs (p <0.01); a SRR of 33% was observed when one histopathological subtype was present vs 94% with 4 subtypes. Furthermore, men with any foci of spermatogenesis had higher SRRs. Conclusions: In men with NOA, increasing testicular histopathological heterogeneity is correlated with higher SRRs driven by the identification of focal areas of spermatogenesis. This is an important, although predictable, observation. While diagnostic biopsy is not routinely required, these findings emphasize the value of having histology to perhaps predict the chance of sperm retrieval for future mTESE procedures. References 1. : CUA Guideline: the workup of azoospermic males. Can Urol Assoc J 2010; 4: 163. Google Scholar 2. : Diagnosis and treatment of infertility in men: AUA/ASRM guideline part II. Fertil Steril 2021; 115: 62. Google Scholar 3. : Microdissection testicular sperm extraction: an update. Asian J Androl 2013; 15: 35. Google Scholar 4. : Microsurgical epididymal sperm aspiration: indications, techniques and outcomes. Asian J Androl 2013; 15: 40. 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Google Scholar © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology12 Aug 2021Editorial Comment Volume 206Issue 5November 2021Page: 1268-1275 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.Keywordsazoospermiasperm retrievalAcknowledgmentThe authors would like to acknowledge Kathleen Hart for her help with maintenance of the clinical database.MetricsAuthor Information Nahid Punjani Department of Urology, Weill Cornell Medical College, New York, New York Supported in part by the Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust. More articles by this author Ryan Flannigan Department of Urology, Weill Cornell Medical College, New York, New York Supported by Vancouver Coastal Health Research Institute. More articles by this author Caroline Kang Department of Urology, Weill Cornell Medical College, New York, New York Supported in part by the Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust. More articles by this author Francesca Khani Department of Urology, Weill Cornell Medical College, New York, New York Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York More articles by this author Peter N. Schlegel Department of Urology, Weill Cornell Medical College, New York, New York ‡Correspondence: New York Presbyterian/Weill Cornell Medicine, 525 E. 68th St., Starr 900, New York, New York 10065 telephone: 212-746-5491; FAX: 212-746-8425; E-mail Address: [email protected] More articles by this author Expand All Advertisement PDF downloadLoading ...