Learning curves of microdissection testicular sperm extraction for nonobstructive azoospermia.
OBJECTIVE
Microdissection testicular sperm extraction (micro-TESE) has been performed at some experienced male infertility centers. Micro-TESE in patients with nonobstructive azoospermia (NOA) has been shown to be not only feasible and safe but also a technically demanding operation. To evaluate whether the improvement of surgical outcomes of micro-TESE, we hereby report the learning curves of micro-TESE for NOA patients.


METHODS
Retrospective clinical analysis.


METHODS
Male infertility center.


METHODS
Since 2006, micro-TESE was performed in 150 patients with NOA by a single surgeon.


METHODS
After the tunica albuginea was opened, direct examination of the testicular parenchyma was performed at x25 magnification.


METHODS
Sperm retrieval rate and clinical factors in the first 50 patients (group A), the middle 50 patients (group B), and the last 50 patients (group C) were examined.


RESULTS
There were no differences in clinical factors among the three groups. Total operation times were shorter in group B and C than in group A (P<0.05). The sperm retrieval rate in group B (44%) and C (48%) was significantly higher than in group A (32%; P<0.05).


CONCLUSIONS
As cases increase, surgical outcomes and sperm retrieval rate have improved. We think that this report showed substantial learning curves for a microscopic surgery such as micro-TESE.
Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan. iskwtmmt@med.kobe-u.ac.jp
Tomomoto
T
Ishikawa
Ryuichiro
R
Nose
Kohei
K
Yamaguchi
Koji
K
Chiba
Masato
M
Fujisawa
D000328:Adult; D053713:Azoospermia / Q000473:pathology / Q000601:surgery*; D004502:Education, Medical, Continuing; D006801:Humans; D007858:Learning / Q000502:physiology*; D008297:Male; D042282:Microdissection / Q000193:education / Q000379:methods / Q000592:standards; D008875:Middle Aged; D009929:Organ Size; D011361:Professional Competence; D012189:Retrospective Studies; D053625:Sperm Retrieval / Q000592:standards; D013737:Testis / Q000473:pathology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult