"Second-look" Micro Testicular Sperm Extraction (MicroTESE) in Patients with Non-obstructive Azoospermia Following Histopathological Analysis

Introduction Microdissection testicular sperm extraction (microTESE) is considered the gold standard method for surgical sperm retrieval among patients with non-obstructive azoospermia (NOA). Aim This study aimed to evaluate the correlation between histopathological findings after failed microTESE procedure and outcomes of the "second-look" procedure and to provide insight into the most common histopathological patterns after testicular biopsy within our population. Methods The retrospective study included 33 selected patients with NOA, who had undergone unsuccessful sperm retrieval. The diagnosis of NOA was made after the assessment of the patient's history data, a physical examination, semen analysis, the hormonal profile, and genetic studies. After negative sperm retrieval, histopathological report has been analyzed for "second-look" microTESE attempt. Results Five testicular histopathological patterns were found: hypospermatogenesis (9,1%), Sertoli cell-only syndrome (43%), germ cell maturation arrest (15%), seminiferous tubule hyalinization (15%), mixed pattern (21%). Y-microdeletions were detected in 5 patients, of which 3 patients showed AZFc region deletions. Only 3 patients (9,1%) underwent a "second-look" procedure after the evaluation of histopathological reports. After the stimulation therapy and "second-look" procedure, we had a positive outcome in a single patient (33,3%). Mean FSH value in patients with confirmed spermatogenesis was 17.26±3.11IU/l, while mean FSH value in patients without presence or germ cell statistically significantly exceeded and was 24.28±4.71IU/L (p=0.038). Conclusion Histopathological reports following the microTESE procedure are obligatory for the proper selection of patients who are candidates for the "second-look" microTESE attempt. Patients with Sertoli cell-only syndrome and hypospermatogenesis particularly can benefit from the "second-look" procedure.