The importance of microdissection testicular sperm extraction intervention after prior failed nonobstructive azoospermia treatment

The manuscript on repeat microdissection testicular sperm extraction (microTESE) after prior failed microTESE for nonobstructive azoospermia (NOA) by Özman et al. (1Özman O. Tosun S. Bayazıt N. Cengiz Bakırcıoğlu M.E. Efficacy of the second micro-TESE first in men with azoospermia.Fertil Steril. 2021; 115: 915-921Scopus (5) Google Scholar) provides a simple message, and it also allows us some insight into success failure procedures. investigators, as lead investigator, identified that procedures had 18% rate, despite procedure. To date, there has been substantial literature published variety different theories potential interventions proposed are purported to increase production sperm, allowing retrieval procedure be more effective NOA who have surgical attempt. Unfortunately, these studies testis (TESE) confounded poor study design because surgery was redone addition medical intervention, no control group comparators. This is simpler, other were attempted, just surgery. Thus, this focus effect Treatment challenging highly dysfunctional condition. Indeed, so reaches ejaculate. Of hundreds seminiferous tubules within testis, only 1 or 2 need work, i.e., complete spermatogenesis, possible. However, finding rare foci functioning fragile tissue can surgically challenging. Further, identifying excised requires dedicated search microsurgical expertise. With anatomical challenges NOA, not surprising series wide range rates, even when applying most successful approach retrieval, (2Schlegel P.N. Sigman M. Collura B. De Jonge C.J. Eisenberg M.L. Lamb D.J. al.Diagnosis treatment infertility men: AUA/ASRM guideline part II.Fertil 62-69Abstract Full Text PDF PubMed Scopus (18) Scholar, 3Bernie A.M. Ramasamy R. Schlegel Predictive factors extraction.Basic Clin Androl. 2013; 23: 5Crossref (45) Scholar). Based discussions experienced surgeons, allowed our sharing real-time observation extensive safely (4Ramasamy Yagan Structural functional changes conventional versus extraction.Urology. 2005; 65: 1190-1194Abstract (212) effectively done, clear operation actually done differently individual surgeons. Some basis operative reports personal communication, examine initially exposed tissues potentially missing ≥30% patients present (5Ramasamy Reifsnyder J.E. Husseini J. Eid P.A. Bryson C. Localization during azoospermia.J Urol. 189: 643-646Crossref (30) variability technique likely results. Sperm, present, inside tissue; thus, mechanical disruption critical identify retrieved laboratory team very those tissues. I always tremendous respect dispersed tissue. Processing tissue, whether surgeon laboratory, identification spermatozoa. chance if does give contains sperm. Prior confused interventions, clomiphene citrate, human chorionic gonadotropin, value intervention provided adequate scientific evidence recommend therapy before initial data demonstrating importance may an dissection find micro–testicular azoospermiaFertility SterilityVol. 115Issue 4PreviewTo evaluate efficacy (TESE)in whom failed. Full-Text