Discordant Bilateral Testicular Pathology Does not Affect Sperm Retrieval Rate in Bilateral Microdissection Testicular Sperm Extraction (mTESE)

OBJECTIVE To assess the incidence of discordant testicular pathology in men undergoing bilateral micro-dissection testicular sperm extraction (mTESE) and association with sperm retrieval rate. METHODS We performed a retrospective single-institutional review of all patients undergoing mTESE from 2007 to 2021 and aggregated clinical history, physical exam, semen analysis, and operative findings. Specimens with discordant pathology were re-reviewed by an experienced genitour-inary pathologist and categorized in a standardized fashion. Data were analyzed using SPSS. RESULTS One hundred fourteen non-obstructive azoospermia men undergoing 132 mTESEs were iden-tified within the study period. Eighty-five percent (112/132) of cases had pathology specimens available, and within this specific cohort the success rate was 41.9% (47/112). A total of 206 pathological reports resulted including 52.4% Sertoli cell only, 4.9% Leydig cell hyperplasia, 8.7% fibrosis, 16.5% maturation arrest, and 17.5% hypospermatogenesis. Twelve percent of testicles had more than 1 pathologic diagnosis. Sixty-six men had synchronous bilateral testi-cular pathology, and 11/66 (16.6%) had at least partially discordant pathology on initial review. Focused re-review by a genitourinary pathologist confirmed exclusively discordant pathology in 7/66 (10.6%) cases, with a sperm retrieval rate of 57% (4/7). The sperm retrieval rate in men with discordant pathology was not significantly different from those with concordant pathology. CONCLUSION Over 1 in 10 men undergoing mTESE may have discordant pathology between testicles, though this may not affect sperm retrieval rate at the time of procedure. Clinicians should consider submitting bilateral testicular specimens for pathology to (1) clarify their outcomes data, and (2) assist with clinical decision-making and surgical planning if a repeat mTESE is indicated. UROLOGY 176: 82-86, 2023. & COPY; 2023 Elsevier Inc. All rights reserved.

Automated summary

A retrospective study found that approximately 10% of men undergoing bilateral micro-dissection testicular sperm extraction (mTESE) had discordant testicular pathology. However, the discordant pathology did not significantly affect the sperm retrieval rate. Therefore, clinicians should consider performing pathology examination on bilateral testicular specimens before surgery to aid in clinical decision-making and surgical planning.