Microdissection is the best way to perform sperm retrieval in men with non-obstructive azoospermy? | Opinion: No, there are other options

Vol. 44 (6): 1067-1070, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2018.06.03


DIFFERENCE OF OPINION

Marcelo Vieira 1, 2
1 Membro Titular da Sociedade Brasileira de Urologia, Rio de Janeiro, RJ, Brasil; 2 Urologista do Projeto ALFA, Sao Paulo, SP, Brasil

Keywords: Azoospermia; Microdissection; Sperm Retrieval; Fertility


In the last 23 years, Intracitoplasmic Sperm Injection (ICSI) has given non-obstructive azoospermic man the opportunity to become biological fathers, if sperm could be found in their testicles. These men present the biggest challenge in the routine of infertility clinics around the World, since there are no positive, clinical or laboratory, prognostic factors for sperm recovery.

Once testicular sperm has been regularly used for ICSI, discussion about which technique for testicular sperm retrieval has been done. Sperm can be harvest from testicular parenchyma by: open biopsy (Testicular Sperm Extraction-TESE), percutaneous aspiration (Testicular Sperm Aspiration), open guided biopsy by previous cytology (Testicular fine-needle Aspiration) and open biopsy using microsurgery technique (Testicular Microdissection). The proposed techniques have the same objective, to find sperm with minimal testicular damage and in a reproducible way (1).

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