Ntial, but controversial indications for varicocele repair, including low testosterone, prevention
Ntial, but controversial indications for varicocele repair, including low testosterone, prevention of NVP-AUY922 site progressive testicular dysfunction, testicular pain and nonobstructive azoospermia [54]. There have been reports suggested increased sperm production in over half of patients leading to detectable sperm in the ejaculate after varicocelectomy in men with azoospermia [55], as well as reports of adequate sperm in the ejaculate after varicocelectomy in as few as 10 of patients [56]. Similarly, there have been both reports of improved sperm retrieval rates after varicocelectomy prior to micro-TESE in patients with nonobstructive azoospermia with a clinical varicocele [57], as well as reports suggesting that the varicocelectomy in these patients does not improve outcomes of microTESE [56]. Because of these conflicting results, the need for varicocelectomy in men prior to micro-TESE for sperm retrieval remains controversial. Haydardedeoglu et al compared men who had NOA and a clinical varicocele to men with NOA and no varicocele. They PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/26266977 found that the men with a varicocele whom underwent varicocelectomy had higher rates of sperm retrieval compared to men with NOA and no varicocele [58], suggesting that the repair of a varicocele in men with NOA may play a predictive role in success of micro-TESE.HistopathologyPerhaps the strongest predictor of successful sperm retrieval is testicular histopathology. Many of the patients that are seen at a large tertiary referral center have had previous fertility counseling or procedures, and it is often helpful to include this data when counseling these patients on their chance of success with micro-TESE. For example, a patient may be seen who has had a testicular biopsy in the past, and because of this his histopathology is known. While many practitioners would not have done or recommended this procedure, the data is available and it is a useful piece of information that can be utilized. When examining the histology of sperm retrieval specimens, the pattern seen can often be suggestive of the production of sperm. It is important to consider whether the histologic pattern analyzed was the most advanced pattern of histology, or the predominant histologic pattern, as the two analyses can provide very different information regarding the patient or testis being described. It has been shown that men with just Sertoli cell-only syndrome (SCO) have a much lower rate of spermatozoa recovery when compared to men with predominantly hypospermatogenesis (HS) and maturation arrest (MA) [21]. Histopathologic specimen alone has been shown to be the strongest single predictor of successful sperm retrieval with conventional techniques [59]. In micro-TESE performed on patients with Klinefelter syndrome, no single preoperativepredictive variable was noted to predict a successful outcome, but there were several variables where an PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/26437915 association was noted. Men with Sertoli cell-only on diagnostic biopsy had a sperm retrieval rate of 70 , and the presence of seminiferous tubules that did not have sclerotic changes during the procedure was associated with the most favorable outcomes [60]. Because histopathology is now usually examined at the time of sperm retrieval and is not typically a preoperative variable, it can be used to determine success of sperm retrieval only if a diagnostic biopsy was performed. One such way would be the use of testicular biopsies before a more definitive sperm retrieval is performed. The use of histopatholo.
