United Knowledge, Expert Care

Micro-Dissection sperm retrieval (TESE)

Mr Minhas has performed a large number of micro-dissection sperm retrievals and has recently published his data in European Urology 2010 and The British Journal of Urology, International.

This technique is used in men with non obstructive azoospermia (NOA). NOA is usually characterised by small testis and raised FSH levels in the blood. It is interesting to note that about 50-60% of men with NOA will harbour small quantities of sperm in the testis although they may not ejaculate them. The principle in sperm retrieval in NOA is too try and optimise the chances of finding sperm whilst reducing the risk of damage to a testis.

Historically, TESA or FNA was used to as a technique of sperm retrieval but it has now been superseded by micro TESE as the procedure of choice of extracting sperm in men with NOA.

This technique is based upon that described by Schlegel in New York.  Under a general anaesthetic an incision is made on the scrotum and both testes are delivered and each testis has an incision made transversely.  Under the microscope, any tubules containing sperm appear to be more dilated and opaque.  It is these tubules, which are given to the embryologists at the time of the micro-dissection and sperm can be extracted from them.

Mr Minhas is an accomplished micro-Surgeon and currently data seems to indicate that the micro-dissection sperm retrieval technique is the optimum technique in terms of sperm retrieval rates, and also reducing post-operative complications.

More recently Mr Minhas has published his results for salvage mTESE in men who have had previous biopsies, with a sperm retrieval rate of almost 50% (see published outcomes).

Before any patients undergo micro-dissection sperm retrieval they will undergo full evaluation with genetic tests and hormone profile.

The overall sperm retrieval rates in men with non-obstructed azoospermia are in the region of approximately 50%.  This data is summarised in the table below and in the outcomes section.

Series n Overall
SR (%)
SCOS
SR (%)
MA
SR (%)
Hypospermatogenesis
SR (%)
Minhas 89 49.4 41.2 26.7 82.6
Okada 2002 74 44.6 33.9 75 100
Colpi 2009 28 48.3 27.5 85.7 100
Ramasamy
2005
460 57 41 44 81

 

For more information, view the summaryof the published article and published outcome data.

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