U J All Final for WEB.pdf 795Vol. 10 | No. 1 | Winter 2013 |U R O LO G Y J O U R N A L Optimal Number of Biopsies and Impact of Testicular Histology on the Outcome of Testicular Sperm Extraction Farid Dadkhah,1,2 Seyed Jalil Hosseini,1 Mohamad Ali Sadighi Gilani,1 Faramarz Farrahi,1 Erfan Amini,2 Behrang Kazeminejad3 Purpose: on outcome. Materials and Methods: a single biopsy of the contralateral testis. Results: - cess rate did not increase considerably after the third sampling. Performing contralateral testicular Conclusion: Keywords: azoospermia, infertility, histology, sperm retrieval Corresponding Author: Erfan Amini, MD Urology and Nephrology Research Center, Shahid Be- heshti University of Medical Sciences, Tehran, Iran Tel: +98 21 8800 2337 Fax: +98 21 2207 4101 E-mail: amini.erfan@gmail. com Received July 2012 Accepted December 2012 1Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute, Tehran, Iran 2Department of Urology, Shahid Modarress Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran 3Department of Pathology, Shahid Modarress Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran SEXUAL DYSFUNCTION AND INFERTILITY 796 | INTRODUCTION Mhave long been considered irrevocably infer- sperm injection (ICSI), these patients have the opportunity to active spermatogenesis, sperm can be retrieved in some infer- Different prognostic factors have been recommended to - topathological pattern is more accurate. Although vari- ous patterns of testicular histology can be treated applying - matogenesis. In addition to the histologic pattern, pres- ence of sperm in prior biopsies also predicts the success conventional TESE, including sampling a larger testicu- lar tissue through a single incision and multiple biopsies through different small incisions in tunica albuginea. There is inconsistency in the literature concerning the optimal of testicular tissue, an impaired testosterone synthesis, rate. Histological pattern and success or failure of previous biopsies may also affect the optimal number of biopsies. We conducted this study to determine the optimal number of success and avoid multiple unnecessary biopsies. We also evaluated the impact of testicular histology and the success sperm retrieval procedure. MATERIALS AND METHODS TESE in our institution. To assess the optimal number of - - - - - cised. The number of biopsies varied according to the pres- - - the contralateral testis. - oratory in Bouin solution. We also reevaluated the histo- - small or atrophied testes, and such patients have not been included in the analysis. (the Statistical Package for the Social Sciences, Version P - cant. RESULTS - Sexual Dysfunction And Infertility 797Vol. 10 | No. 1 | Winter 2013 |U R O LO G Y J O U R N A L Sperm Retrieval and Histopathology | Dadkhah et al - esis, germ cell maturation arrest, SCO appearance, and hy- - genesis, early maturation arrest, late maturation arrest, SCO - ond, third, fourth, and contralateral sampling, respectively. - - pling. - ferent histopathological patterns and noted a considerable - esis. Although contralateral testicular biopsy yielded no - - success rate of TESE in different histopathological patterns according to the number of biopsies. - - ence or absence of spermatozoa in their testicular biopsy - tozoa (Sp+ negative biopsies (Sp-). Sertoli cell only and hypospermato- Sp+ subgroups, respectively (Table 2). - successful sperm retrieval irrespective of histopathologi- + patients of the result of prior biopsy, performing more than three biopsies, including contralateral testicular biopsy, did not outcome of prior biopsy and histopathology of the testis P - ever, routine postoperative ultrasonography and testoster- and hypoandrogenism, respectively. DISCUSSION - ously considered infertile may father children. Isolated foci Table 1. Cumulative incidence of positive testicular sperm extraction according to the number of biopsies in different histopathologi- cal patterns. Histopathological pattern Number of biopsies Contralateral biopsy 1 2 3 4 Uniform hypospermatogenesis 114 (73.5%) 132 (85.2%) 141 (91.0%) 147 (94.8%) 151 (97.4%) Early maturation arrest 64 (46.4%) 75 (54.3%) 81 (58.7%) 83 (60.1%) 83 (60.1%) Late maturation arrest 22 (20.6%) 26 (24.3%) 29 (27.1%) 29 (27.1%) 29 (27.1%) Sertoli cell only 29 (17.8%) 35 (21.5%) 41 (25.1%) 41 (25.1%) 41 (25.1%) Hypospermatogenesis with mixed pattern 101 (56.7%) 113 (63.5%) 124 (69.7%) 133 (74.7%) 137 (77.0%) 798 | men. There is no consensus regarding the optimal number - thors hypothesize that multifocal distribution of the sper- matogenesis is present throughout the entire testis and ac- cordingly, advocate a single testicular biopsy production and recommend multiple samples from differ- ent sites. Comparing mul- tiple and single sampling, Amer and associates revealed a Nevertheless, multiple sampling has been postulated to be - - tion of the number of biopsies and avoiding unnecessary multiple samplings may prevent the potential hazards of biopsy. - terns and accordingly performing multiple biopsies from different sites may be of greater importance in these his- - In our study, multiple testicular sampling, including con- - also evident in adverse histopathological patterns, includ- in case of SCO and late maturation arrest, further biopsies Table 2. Frequency of different histopathological patterns in patients with positive and negative prior testicular biopsy.* Histopathological pattern from TESE specimens Patients with Sp + Patients with Sp - Total Uniform hypospermatogenesis 63 (64.9%) 34 (35.1%) 97 (100%) Early maturation arrest 27 (37.5%) 45 (62.5%) 72 (100%) Late maturation arrest 4 (8.9%) 41 (91.1%) 45 (100%) Sertoli cell only 12 (11.3%) 94 (88.7%) 106 (100%) Hypospermatogenesis with mixed pattern 48 (39.7%) 73 (60.3%) 121 (100%) *TESE indicates testicular sperm extraction; Sp+, patients with positive prior biopsy; and Sp-, patients with negative prior biopsy. Table 3. Cumulative incidence of positive testicular sperm extraction according to the number of biopsies and the result of prior biopsy in different histopathological patterns. Histopathological pattern Number of biopsies Contralateral biopsy 1 2 3 4 Uniform hypospermatogenesis Sp+ 55 (87.3%) 60 (95.2%) 63 (100%) - - Sp- 25 (73.5%) 31 (91.2%) 34 (100%) - - Early maturation arrest Sp+ 18 (66.7%) 22 (81.5%) 25 (92.6%) 27(100%) - Sp- 22 (48.9%) 25 (55.5%) 27 (60.0%) 27 (60.0%) 27(60.0%) Late maturation arrest Sp+ 2 (50%) 4(100%) 4 (100%) 4 (100%) - Sp- 9 (21.9%) 11 (26.7%) 12 (29.3%) 12 (29.3%) 12 (29.3%) Sertoli cell only Sp+ 6 (50.0%) 8 (66.7%) 10 (83.3%) 10 (83.3%) 10 (83.3%) Sp- 16 (17.0%) 18 (19.1%) 20 (21.3%) 20 (21.3%) 20 (21.3%) Hypospermatogenesis with mixed pattern Sp+ 32 (66.7%) 36 (75.0%) 41 (85.4%) 46 (95.8%) 48 (100%) Sp- 43 (58.9%) 46 (63.0%) 48 (65.7%) 50 (68.5%) 50 (68.5%) Sp+ indicates patients with positive prior biopsy; and Sp-, patients with negative prior biopsy. Sexual Dysfunction And Infertility 799Vol. 10 | No. 1 | Winter 2013 |U R O LO G Y J O U R N A L Sperm Retrieval and Histopathology | Dadkhah et al - opsies in each histopathology category. Nevertheless, the importance of performing multiple biopsies cannot be un- - form hypospermatogenesis. patchy distribution of spermatogenesis. This term has re- and has changed prior methods of interpretation of histo- reported.(22) spermatogenesis precludes the diagnosis of SCO.(22) Both prior successful TESE and biopsy have been associ- (23) A ret- In the +), and the success rate -) varied from The likelihood of Sp+ - + no germ cells are found. Therefore, the sperm retrieval rate is present in the literature. This overestimation may be re- lated to the absence of germ cells in the biopsied specimen, - tissue and considering that only a small specimen from a - - cerning testicular histology. Histopathology is not applica- - - histopathological diagnosis, it may be helpful in planning prior to TESE procedure. In the case of hypospermatogen- presence of spermatozoa is relatively high and performing further biopsies may improve the outcome. Fine needle aspiration biopsy is a simple and less invasive - no complication. Despite high success rate in some stud- - cessful more often than aspiration biopsy.(26,27) Neverthe- less, it should be considered that prior history of successful pre-operatively, can provide an opportunity to apply aspira- tion biopsy prior to open surgery. In these conditions, there conventional TESE to minimize the testicular tissue loss and enhance retrieval success rate. Some investigators have rate. - There- - - tern(2,32) - 800 | REFERENCES 1. Vernaeve V, Verheyen G, Goossens A, Van Steirteghem A, Devroey P, Tournaye H. How successful is repeat testicular sperm extraction in patients with azoospermia? Hum Reprod. 2006;21:1551-4. 2. 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