The following is a summary of “Discordant Bilateral Testicular Pathology Does not Affect Sperm Retrieval Rate in Bilateral Microdissection Testicular Sperm Extraction (mTESE),” published in the JUNE 2023 issue of Urology by Bole, et al.

For a retrospective single-institutional review, researchers sought to assess the incidence of discordant testicular pathology in men undergoing bilateral microdissection testicular sperm extraction (mTESE) and its association with sperm retrieval rate.

They conducted a retrospective analysis of 114 men with non-obstructive azoospermia.ßmen who underwent 132 mTESE procedures between 2007 and 2021 at a single institution. Data collected included clinical history, physical exam, semen analysis, and operative findings. Pathology specimens were re-reviewed by an experienced genitourinary.ßpathologist and categorized accordingly. Data analysis was performed using SPSS.

Among the 132 mTESE procedures, 85% (112 cases) had pathology specimens available, and the overall success rate in this subgroup was 41.9% (47/112). The pathological reports yielded the following categories: 52.4% Sertoli cell only, 4.9% Leydig cell hyperplasia, 8.7% fibrosis, 16.5% maturation arrest, and 17.5% hypospermatogenesis. Notably, 12% of testicles had more than one pathologic diagnosis. Among the 66 men with synchronous bilateral testicular pathology, 16.6% (11/66) had at least partially discordant pathology on the initial review. A focused re-review by a genitourinary pathologist confirmed exclusively discordant pathology in 10.6% (7/66) of cases. The sperm retrieval rate in men with discordant pathology was 57% (4/7), which was not significantly different from those with concordant pathology.

The study highlighted that around 1 in 10 men undergoing mTESE may have discordant testicular pathology between their testicles. However, this does not seem to impact the sperm retrieval rate at the time of the procedure. Clinicians should consider submitting bilateral testicular specimens for pathology to improve outcomes data and aid in clinical decision-making and surgical planning, especially if a repeat mTESE is being considered.

Source: goldjournal.net/article/S0090-4295(23)00308-4/fulltext