title: Conventional multiple or microdissection testicular sperm extraction: a comparative study.
abstract: BACKGROUND
  Testicular sperm extraction (TESE) with ICSI is becoming the first-line treatment for non-obstructive azoospermia (NOA). Recently, the sperm retrieval rate (SRR) by microdissection TESE was reported to be higher than by conventional TESE. However, a comprehensive comparison between multiple and microdissection TESE patients including histological findings has not been reported.
  
  
  METHODS
  Patients with NOA who underwent microdissection TESE (n = 56) or multiple TESE (n = 37) were compared. Pre-operative characteristics were similar between groups. In addition, microscopic findings during microdissection TESE also were investigated.
  
  
  RESULTS
  Operative time was significantly longer for microdissection TESE than for multiple TESE. Histological examination suggested that spermatogenesis was relatively more impaired in the microdissection TESE group than in the multiple TESE group. Despite this, SRR by microdissection TESE (42.9%) appeared higher than by conventional TESE (35.1%) although this observation failed to reach statistical significance. Seventeen of 26 patients (65.4%) with heterogeneous tubule were successful for sperm retrieval. No severe operative complications occurred in any patient in either group, and no patient required post-operative hormone replacement to treat hypogonadism.
  
  
  CONCLUSIONS
  Microsurgical technique is safe and may improve SRR for TESE in a variety of patients with NOA, especially patients with heterogeneous testicular tubules.
authors.affiliation: Department of Urology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Tsujimura
authors.forename: K
authors.initials: K
authors.lastname: Matsumiya
authors.forename: Y
authors.initials: Y
authors.lastname: Miyagawa
authors.forename: A
authors.initials: A
authors.lastname: Tohda
authors.forename: H
authors.initials: H
authors.lastname: Miura
authors.forename: K
authors.initials: K
authors.lastname: Nishimura
authors.forename: M
authors.initials: M
authors.lastname: Koga
authors.forename: M
authors.initials: M
authors.lastname: Takeyama
authors.forename: H
authors.initials: H
authors.lastname: Fujioka
authors.forename: A
authors.initials: A
authors.lastname: Okuyama
mesh_terms: D000328:Adult; D004210:Dissection; D006801:Humans; D008297:Male; D009845:Oligospermia / Q000473:pathology / Q000503:physiopathology; D013091:Spermatogenesis; D013094:Spermatozoa; D013737:Testis / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D020858:Tissue and Organ Harvesting / Q000379:methods*