Microdissection TESE is superior to conventional TESE in patients with nonobstructive azoospermia caused by Y chromosome microdeletions.

Nonobstructive azoospermia is caused in up to 10% by microdeletions of the Y chromosome in the azoospermia factor (AZF) region, which is divided into three nonoverlapping areas (AZFa, AZFb and AZFc). In 25 male patients with AZF microdeletions, the results of two different techniques for surgical sperm retrieval (SR), conventional multilocular TESE and microdissection TESE, were studied retrospectively over a period of 19 years. Conventional multilocular TESE was carried out in 11 patients and microdissection TESE in 14 patients. Successful SR was possible only in patients with isolated AZFc microdeletions, so only the 20 patients with AZFc microdeletions alone were taken into account for the comparison of the both operative techniques. The sperm detection rate for conventional multilocular TESE was 25%, the sperm detection for microdissection TESE was significantly higher with 67%. In all patients, a histological examination of the testicular tissue was carried out, which showed a mixed picture, but Sertoli-cell-only syndrome in most cases. FSH was no prognostic marker for successful SR. In two of six couples performing an intracytoplasmic sperm injection until now, a pregnancy occurred.

Refertilization surgery. A surgeon's experience of over 27 years with nearly 2000 patients.

AIM: The aim of this paper was to present the experiences of microsurgical refertilization in a single-centre study during a period of 27 years. METHODS: Nearly 2000 patients were operated by a single surgeon (JUS). A total of 1708 patients were evaluated in a data base, 1164 were available for a follow-up. Both vasovasostomy (VV) and epididymovasostomy (EV) were carried out in a three-layer technique. Vasectomy reversal (VR) end-to-end VV was performed only if spermatozoa had been demonstrated at the epididymal stump of the vas. In all other cases of VR, EV was done in a preocclusive region of the epididymal tubule. In the cases of postinfectious obstruction (PIO) of seminal pathways, an EV was always carried out. RESULTS: The outpatient procedure of refertilization was associated with a very low complication rate, which underlines its minimal-invasive character. The follow-up rate was 68%, the overall patency rate was 88% for VR and 67% for PIO and the pregnancy rate was 59% for VR and 38% for PIO. Secondary azoospermia was observed in 1% of the patients. CONCLUSION: In relation to the intervals of obstruction, the patency and pregnancy rates were higher after short-term obstruction than after long-term obstruction. There is a significant discrepancy between patency and pregnancy rates that is likely to be caused by a relevant number of patients with postoperative asthenozoospermia.

The role of shortening procedures for the surgical therapy of Peyronie's disease.

In this article we briefly review the current surgical treatment options for Peyronie's disease (PD) in its stable phase. We emphasize the important role of tunical shortening procedures which account for the major share of operations for PD. Shortening procedures provide excellent curvature correction combined with a very low risk of new erectile dysfunction. Since erectile function is already heavily impaired by the disease and its comorbidities in many patients with PD, tunical shortening procedures often are the treatment of choice for the correction of penile curvature. While there is no hard evidence for the superiority of a specific shortening procedure, several authors prefer the classical Nesbit technique over simple plication techniques. We also present our experiences with the Tunica albuginea underlap technique (TAU-technique), a new modification of the Nesbit procedure, that might add further surgical advantages while preserving the strength of the classical Nesbit technique.