Meaning Touch Imprint and Testicular Sperm Extraction(TEST) in Azoospermia Patients during Testis Biopsy

Kim, Soo Woong; Paick, Jae Seung

Abstract

PURPOSE: Because testicular biopsy traditionally has been performed as a separate operation, there are some needs for immediate interpretation of the testicular biopsy specimen in obstructive azoospermia patients. The realization that a proportion of patients with nonobstructive azoospermia harbor spermatozoa in their testicular parenchyma, combined with the ability of intracytoplasmic sperm injection(ICSI) to effect pregnancy with single sperm, has prompted clinicians to explore testicular sperm extraction(TESE) in these patients. We performed this study to investigate the meaning of touch imprint and TESE.
MATERIALS AND METHODS
Fifty-two patients with azoospermia underwent touch imprint, TESE and simultaneous formal testicular biopsy. Testicular biopsy tissue was touched on a slide and stained using a Diff-Quik method. Tissue obtained from TESE was analyzed by intensive searching to find spermatozoa.
RESULTS
Twenty-nine patients were determined as obstructive azoospermia including two cases of hypospermatogenesis, all patients had sperm seen on touch imprint and TESE. The other patients were diagnosed as nonobstructive azoospermia, testicular histology was divided into two main patterns: Sertoli cell only syndrome, spermatocytic arrest. Touch imprint failed to show sperm, but three of twenty patients(15%) with Sertoli cell only syndrome had sperm present during TESE. CONCLUSIONS: Touch imprint provides high quality cellular detail for immediate review, which can minimize the intraoperative time required to decide upon the appropriateness of correcting the ductal obstruction in obstructive azoospermia patients. Men with nonobstructive azoospermia may have mature spermatozoa present within their testicular parenchyma. Therefore intensive searching for presence of spermatozoa should be performed in tissue obtained from TESE by trained specialist.