title: Testicular fine-needle aspiration versus testicular open biopsy: Comparable sperm retrieval rate in selected patients.
abstract: BACKGROUND
  Sperm recovery by testicular fine-needle aspiration (TESA) has resulted in variable sperm retrieval rate (SRR) and is generally considered inferior to open biopsy (testicular sperm extraction [TESE]).
  
  
  OBJECTIVE
  To develop a predictive model for SRR by TESA and to identify factors associated with comparable SRR between TESA and TESE.
  
  
  METHODS
  Single-center controlled cross-sectional study on 450 infertile men with nonobstructive azoospermia.
  
  
  METHODS
  Clinical, paraclinical, and histological information of patients were gathered. All patients underwent both TESA and TESE in a single operation. Predictors of SRR by TESA were identified, and the accuracy of TESA in predicting the outcome of TESE was determined.
  
  
  METHODS
  Categorical and continuous variables were compared using independent t test and -chi-square test. Logistic regression model was applied to develop a predictive model for SRR by TESA. Receiver Operating Characteristics (ROC) curve analysis was used to determine the accuracy of TESA in predicting TESE outcome.
  
  
  RESULTS
  Sperm retrieval rate for TESA and TESE was 41.8 and 50.9%, respectively (P = 0.04). Age, duration of infertility, testis volume, luteinizing hormone, prolactin, and testosterone did not differ between patients with and without mature sperm in TESA samples. Serum follicular-stimulating hormone (FSH) < 15 IU/l (Exp (B) = 4.8, 95% CI: 1.4-18.5; P = 0.001) and histology of hypospermatogenesis (Exp (B) = 6.4, 95% CI: 2.1-27.4; P < 0.001) were predictors of SRR by TESA. In patients with FSH < 15 IU/l (57.4% versus 59.5%; Area under the curve (AUC) = 0.907) and testicular histology of hypospermatogenesis (68.0% versus 70.5%; AUC = 0.890), the SRR by TESA was predictive of SRR by TESE.
  
  
  CONCLUSIONS
  Serum FSH and testicular pathology were predictors of SRR by TESA. Patients with FSH < 15 IU/l and/or testicular pathology of hypospermatogenesis had comparable SRR by TESA versus TESE.
authors.affiliation: Department of Urology, Imam-Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Nowroozi
authors.forename: Hamed
authors.initials: H
authors.lastname: Ahmadi
authors.forename: Mohsen
authors.initials: M
authors.lastname: Ayati
authors.forename: Hasan
authors.initials: H
authors.lastname: Jamshidian
authors.forename: Ali
authors.initials: A
authors.lastname: Sirous