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Microdissection TESE ( mTESE ) following adult orchidopexy for undescended intra‐abdominal and inguinal testicles – surgical techniques and outcomes from a single‐centre cohort
Author(s) -
Sangster P.,
Alnajjar H. M.,
Ahmed K.,
Christodoulidou M.,
Williamson E.,
Kelly J. D.,
Dawas K.,
Ralph D.,
Muneer A.
Publication year - 2020
Publication title -
andrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.947
H-Index - 43
eISSN - 2047-2927
pISSN - 2047-2919
DOI - 10.1111/andr.12679
Subject(s) - azoospermia , medicine , sperm retrieval , microdissection , inguinal canal , surgery , semen analysis , gynecology , infertility , inguinal hernia , biology , hernia , pregnancy , biochemistry , genetics , gene
and objectives Adult undescended testicles ( UDT s) often present to fertility specialists with subfertility or azoospermia and with either an intra‐abdominal or inguinal testicle(s). Performing an orchidopexy followed by a surgical sperm retrieval ( SSR ) is a potential option to retrieve spermatozoa. A microdissection TESE ( mTESE ) procedure is performed to retrieve mature spermatozoa for use in ICSI . This paper reviews the outcomes of mTESE in adults following an orchidopexy. Material and methods A cohort of azoospermic patients underwent adult orchidopexy over a 10‐year period at a single specialist centre. Data were collected retrospectively from the patient records retrieved from an institutional database. All patients underwent pre‐operative imaging to localize the testicles, serum testosterone levels and a semen analysis. Separate intraoperative testicular biopsies were performed to exclude intratubular germ cell neoplasia ( ITGCN ) and to analyse the Johnsen score. Results Twelve patients (age range 18–36 years) underwent orchidopexy procedures for either intra‐abdominal or inguinal testicles. Mean follow‐up was 34 months (range 13–58). Ninety per cent of patients had bilateral UDT with azoospermia. Pre‐operative testosterone levels were within the normal range (mean 13.9 nmol/L; range 9.1–24.2). Five pelvic testicles (from four patients) were brought down and underwent a delayed mTESE . A total of nine inguinal orchidopexy procedures were carried out in eight men, and spermatozoa were found and preserved in three patients. None of the men with intra‐abdominal testicles had mature spermatozoa present following a delayed mTESE . Overall, SSR was successful in 37.5% of the patients. Histological analysis showed no cases of ITGCN and the Johnsen scores ranged from 1 to 3.3. Conclusions Microdissection TESE following orchidopexy for inguinal testicles can result in a successful SSR in over 1/3rd of patients. Intra‐abdominal testicles appear to lack spermatogonia although the testicles can still be preserved for endogenous hormone production. Adult orchidopexy allows preservation of endogenous testosterone, easier self‐examination and an immediate or delayed mTESE in azoospermic patients .