NE-AUA 2006 Annual Meeting, September 28 - 30, 2006, The Westin Hotel & Rhode Island Convention Center Providence, Rhode Island
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Repeat Testicular Sperm Extraction (TESE): Outcome, Clinical Correlates and Complications of Different Intervals between First and Subsequent TESE
Hasan M. El-Fakahany, MD1, Andrew S. Nisbet, M.D.2, Stanton C. Honig, MD3.
1Al-Minya Faculty of Medicine, Al-Minya, Egypt, 2University of Connecticut, Farmington, CT, USA, 3Urology Center, University of Connecticut, New Haven and Farmington, CT,

Background: The introduction of ICSI with testicular sperm extraction (TESE) has changed the treatment options for azoospermic men whether it is obstructive (OA) or non-obstructive (NOA). While in OA, sperm can be surgically retrieved in 100% of cases, in NOA, sperm can be retrieved in only 50% (Tournaye et al, 1997), as these patients may have only small foci of active spermatogenesis (Amer et al, 1999). The objective of our study is to assess whether the intervals between repeated TESE procedures for NOA patients affect the outcome and/or the complications.
Methods: Retrospective chart review was performed on all patients undergoing TESE/ICSI over a 7-year period. Patients were included if they had evidence of non-obstructive azoospermia documented with several centrifuged semen analysis. Patients were excluded if testis histology and/or TESE findings were consistent with normal spermatogenesis. 107 patients charts were reviewed and all patients who were subjected to at least two TESE procedures in our clinic were included. 21 patients met the inclusion criteria and clinical data, surgical outcome, intervals between procedures, and complications were analyzed. All patients underwent open TESE without microdissection.
Results: Of the 21 patients, 13 had two TESE, 7 patients had three TESE, and 1 patient had 4 TESE procedures. Interval between TESE procedures ranged from two months to ten years. 90.5% (19/21 pts) of pts had sperm seen on the initial TESE. Of patients with a successful first TESE, 89% (17/19 pts) had a successful second TESE. Of pts undergoing a third TESE, 86% (6/7pts) had sperm retrieved and 100% of patients undergoing 4 TESE had sperm retrieved (1/1). There was no correlation between success of repeated TESE and testis size or FSH levels. Intervals between procedures did not affect the outcome of the second TESE if the first TESE was successful. When using one-year or less interval between procedures with the first TESE being successful, the success rate of second TESE was 92.3% (<one year) and 83.3% (>one year) respectively. Of pts undergoing repeat TESE less than 6 months from previous, all retrievals (5/5 pts) were successful.Post-operative complications were rare and no difference was seen with differing intervals.
Conclusions: Repeat TESE is a safe and highly efficacious procedure in patients with NOA. Different intervals between procedures appear not to affect sperm retrieval rates if the first procedure was successful. Even short intervals of less than 6 months between TESE show high success rates.


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