Comparison of upper, middle, and lower pole pathologic biopsies of the testes in patients with non-obstructive azoospermia.

Abstract

Introduction: Infertility is a widespread global health issue with a multifactorial etiology, affecting a significant proportion of couples. Male factors, either alone or in combination with female factors, play a crucial role in contributing to infertility. Non-obstructive azoospermia (NOA), characterized by the absence of sperm in the ejaculate due to spermatogenic failure, represents one of the most severe forms of male infertility. Microdissection testicular sperm extraction (m-TESE) has emerged as a primary therapeutic approach for these patients. This study aimed to investigate histopathologic variances between different poles of the testicles in NOA patients undergoing m-TESE and to compare the results using the Johnsen testicular biopsy classification.

Methods: Forty-two consecutive NOA patients who underwent m-TESE between November 2022 and December 2023 were included in this prospective study. Data on patient demographics, perioperative variables, and postoperative outcomes were collected and analyzed. Testicular biopsies from the upper, middle, and lower poles were histopathologically examined, and the Johnsen testicular biopsy scoring system was used for comparison.

Results: Histologic evaluation revealed Sertoli cell only syndrome in nine cases (SCO), maturation arrest (MA) in 12 cases, and hypospermatogenesis (HS) in 21 cases. Pathologic findings were consistent across all poles of the testicle. Johnsen testicular biopsy scores showed similar results among patients. The success rates of sperm retrieval varied, with two of nine patients with SCO, four of 12 with MA, and 16 of 21 with HS achieving successful results.

Conclusions: Our study demonstrated consistent histopathologic patterns across different poles of the testis, emphasizing the importance of comprehensive histologic assessment for predicting sperm retrieval success. As a result of our study, we found that the upper middle and lower poles of the testis were similar in terms of histologic and Johnsen testicular biopsy scoring system. Future research should focus on refining histopathologic classification systems and further optimizing surgical techniques to enhance outcomes in this patient population.