Introduction: Microdissection testicular sperm extraction (mTESE) represents the current gold standard for sperm retrieval in non-obstructive azoospermic (NOA) men. Despite being described over 20 years ago, however, overall success rates remain modest at roughly 50-60%, and the only consistent predictor of success is testicular pathology. It is currently unknown what portion of men have discordant testicular pathology when undergoing a bilateral procedure. The objective of this study is to assess the incidence of discordant testicular pathology in men undergoing bilateral mTESE.
Methods: We performed a retrospective single-institutional review of all patients undergoing mTESE from 2007-2021 and aggregated clinical history, physical exam, semen analysis, and sperm retrieval rates. Where available, permanent pathology specimens were reviewed by an experienced GU pathologist and categorized in a standardized fashion. Data was aggregated in Microsoft Excel and analyzed using SPSS.
Results: We identified a total of 159 unique men undergoing a total of 181 mTESEs from 204 testicles (97 left, 204 right) within the study period. Overall sperm retrieval rate (SRR) was 57%. 73% of all cases had unilateral or bilateral pathology specimens available, and within this specific cohort the success rate was 44%. A total of 235 pathological diagnoses were made including 49% sertoli cell only, 3% leydig cell hyperplasia, 9% fibrosis, 16% maturation arrest, 11% hypospermatogenesis, and 13% active spermatogenesis. 73 men had synchronous bilateral testicular pathology available, and 12/73 (16%) had at least partially discordant pathology. Of these 12 men, 7 had partially overlapping pathological diagnoses, and 5 had truly exclusive discordant pathologies. The SRR in men with discordant pathology was not statistically significant from the overall cohort.
Conclusions: Roughly 1 in 6 men undergoing mTESE may have discordant testicular pathology between testicles. Clinicians should consider this possibility when counseling men on SRR who have prior pathology data available. Submitting bilateral pathology specimens may assist with clinical decision making if considering a repeat procedure after a failed or inadequate primary procedure.
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