Journal Article Epublish 1 citation
PubMed: 39941640 DOI: 10.3390/jcm14030970
Preliminary Results of Microsurgical Sperm Retrieval in Azoospermic Patients: A Randomized Controlled Trial Comparing Operating Microscope vs. Surgical Loupes.
J Clin Med 14(3)
Authors: Mirko Preto, Luca Boeri, Lorenzo Cirigliano, Marco Falcone, Valentina Parolin, Federica Peretti, Ilaria Ferro, Natalia Plamadeala, Martina Scavone, Emanuele Zupo, Paolo Gontero
Affiliations
- Urology Clinic, A.O.U. "Città della Salute e della Scienza", Molinette Hospital, University of Turin, 10126 Torino, Italy.
- IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy.
- Neurourology Clinic, A.O.U. "Città della Salute e della Scienza", Unità Spinale Unipolare, 10126 Turin, Italy.
- Department of Surgical Sciences-Urology, Città della Salute e della Scienza di Torino, University of Turin, 10126 Torino, Italy.
- Department of Urology, School of Medicine, Biruni University, 34015 Istanbul, Turkey.
Abstract
To compare surgical outcomes and sperm retrieval rates (SRRs) between conventional microsurgical-assisted testicular sperm extraction (m-TeSE-Group A) and testicular sperm extraction performed with surgical loupes (l-TeSE-Group B) in adult males with non-obstructive azoospermia (NOA). A multicentric prospective randomized trial (ethics committee no. 202/2022) in accordance with the CONSORT guidelines was conducted from March 2022 to April 2024. Adult males with NOA without genetic alterations who signed the informed consent were enrolled. SRRs, intra- and postoperative complications (according to the Clavien-Dindo classification), and hormonal profile changes were considered as outcomes during the follow-up period. A total of 42 NOA patients were enrolled. The median age was 35 years (IQR: 33-49). The preoperative median FSH was 16.5 mIU/mL (IQR: 11.6-22.5) and the total testosterone was 4.6 (3.5-5.6). Overall, the SRR was 22.6%, with sperm retrieved from 19 testes. Histopathological findings reported Sertoli cell-only syndrome (SCOS) in 46.4% (39 cases), hypospermatogenesis in 26.2%, and germ cell arrest in 26.2% of the patients. No intraoperative complications were recorded. The postoperative complications were minimal (Clavien-Dindo grade I), but no significant differences were recorded in-between the two surgical approaches. Considering the operative time of the testicular exploration alone, Group B seemed to be faster than the m-TeSE, with a median time saving of 8 min ( < 0.01). The use of surgical loupes was safe and comparable with m-TeSE in terms of the SRRs and complication rates. L-TeSE offered a reduction in the operative time compared with m-TeSE.
MeSH
Cells, Sperm Retrieval, Cryopreservation, Operative Time, Infertility, Male, Spermatozoa, Postoperative Complications