Longitudinal vs Horizontal Capsular Incision! Does it Alter Micro-TESE Outcome

  • Hani Albadawe Johns Hopkins Aramco Healthcare ,Dhahran , kingdom of saudi Arabia
  • Rizwanul Haque Ministry of the National Guard- Health Affairs, Riyadh, Saudi Arabia
  • Naif Alhifthi Security Forces Hospital, Riyadh, Saudi Arabia
  • Abdullah Almousa Prince Sultan Military Medical City, Riyadh, Saudi Arabia
  • Turki A Alferayan Ministry of the National Guard- Health Affairs, Riyadh, Saudi Arabia
  • Khalid A Alrabeeah 2 Ministry of the National Guard- Health Affairs, Riyadh, Saudi Arabia, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
  • Saad M Abumelha Johns Hopkins Aramco Healthcare ,Dhahran , kingdom of saudi Arabia, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
Keywords: Male, Infertility, Azoospermia, Sperm, Testis


Micro-TESE (Testicular Sperm Extraction), a procedure performed for treatment of Non-Obstructive Azoospermia, a leading infertility issue among males globally accounting for about 7% of the male population. Azoospermia is the absence of sperms in ejaculate upon semen analysis, 2% of the global population has encountered. A lot is discussed upon sperm retrieval success in both variants of Micro-TESE, which are Transverse or horizontal and longitudinal or vertical approaches, established studies have identified about 45% to 65% of success retrieving spermatozoa. The objective is the identification of the success of both the variants of procedure separately and also of postop complications to both approaches for micro-TESE. A cohort study, for which data, secondary (retrospective), was obtained from King Abdulaziz Medical City (KAMC), Riyadh. The time frame for data covered January 2016 to November 2018; 87 patients underwent micro-TESE, as in the logbook available in “Best Care System at KAMC. Data obtained was analyzed using SPSS Software, 87 of these patients who underwent micro-TESE procedure, 45 were done with the transverse approach and 42 with longitudinal approach, accounting for 51.7% and 48.3%, respectively. Upon postop evaluation, in the transverse approach, sperm were retrieved in 25.29% and for the longitudinal approach, retrieval was about 19.54%. The success rate was 48.9% out of 45 procedures in the transverse approach and 40.5% out of 42 procedures in the vertical/Longitudinal approach. The most common reported post-operative complication in transverse type was atrophy 20% and pain 13.3% on other hand common complications recorded for vertical type, atrophy was about 17.2% and pain in12.6% of patients. Not much statistical significance was observed between the transverse and longitudinal approach in either of the outcomes whether it is success rate or post-op complications. Both approaches are influenced by the factors of surgeon expertise and certain other factors that include pre and postop hormonal therapy, baseline hormonal status, and ICSI.


Download data is not yet available.


Palermo GD, Neri QV, Takeuchi T, Rosenwaks Z. ICSI: where we have been and where we are going. Seminars in Reproductive Medicine. 2009;27(2):191-201. doi: 10.1055/s-0029-1202309.

Jarow JP, Espeland MA, Lipshultz LI. Evaluation of the azoospermic patient. American Urology Asociation Journals, Journal of Urology. 1989;142(1):62-65. doi: 10.1016/s0022-5347(17)38662-7.

Dabaja AA, Schlegel PN. Microdissection testicular sperm extraction: an update. Asian Journal of Andrology. 2013;15(1):35-9. doi: 10.1038/aja.2012.141.

Rajfer J. TESA or TESE: Which Is Better for Sperm Extraction? Reviews in Urology. 2006;8(3):171. PMC1578547.

Palermo GD, O'Neill CL, Chow S, et al. Intracytoplasmic sperm injection: state of the art in humans. Society of Reproduction and Fertility; Reproduction. 2017;154(6):F93-F110. doi: 10.1530/REP-17-0374.

Sullivan EA, Zegers-Hochschild F, Mansour R, et al. International Committee for Monitoring Assisted Reproductive Technologies (ICMART) world report: assisted reproductive technology 2004. Human Reproduction (Oxford, England). 2013;28(5):1375-1390. doi: 10.1093/humrep/det036.

Amer M, Ateyah A, Hany R, Zohdy W. Prospective comparative study between microsurgical and conventional testicular sperm extraction in non-obstructive azoospermia: follow-up by serial ultrasound examinations. Human Reproduction (Oxford, England). 2000;15(3):653-656. doi:10.1093/humrep/15.3.653.

Schlegel PN. Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision. Human Reproduction (Oxford, England) 1999;14(1):131-135. doi: 10.1093/humrep/14.1.131.

Shah R. Surgical sperm retrieval: Techniques and their indications. Indian Journal of Urology. 2011;27(1):102-109 doi: 10.4103/0970-1591.78439.

Ramasamy R, Schlegel PN. Microdissection testicular sperm extraction: effect of prior biopsy on success of sperm retrieval. American Urology Association Journals, Journal of Urology. 2007;177(4):1447-1449 doi: 10.1016/j.juro.2006.11.039.

Janosek-Albright KJC SP, Dabaja AA. Testis sperm extraction. Asian Journal of Urology. 2015;2(2):79-84 doi: 10.1016/j.ajur.2015.04.018.

Schoysman R, Vanderzwalmen P, Nijs M, et al. Pregnancy after fertilisation with human testicular spermatozoa. The Lancet (London, England). 1993;342(8881):1237. doi: 10.1016/0140-6736(93)92217-h.

Silber SJ, Nagy Z, Liu J, Tournaye H, Lissens W, Ferec C, et al. The use of epididymal and testicular spermatozoa for intracytoplasmic sperm injection: the genetic implications for male infertility. Human Reproduction (Oxford, England). 1995;10(8):2031-2043. doi: 10.1093/oxfordjournals.humrep.a136231.

Flannigan R, Bach PV, Schlegel PN. Microdissection testicular sperm extraction. Translational Andrology and Urology. 2017;6(4):745-752. doi: 10.21037/tau.2017.07.07.

Schlegel PN, Li PS. Microdissection TESE: sperm retrieval in non-obstructive azoospermia. Human Reproduction Update. 1998;4(4):439. doi: 10.1093/humupd/4.4.439.

Silber SJ. Microsurgical TESE and the distribution of spermatogenesis in non-obstructive azoospermia. Human Reproduction (Oxford, England). 2000;15(11):2278-2284. doi: 10.1093/humrep/15.11.2278.

How to Cite
Albadawe, H., Haque, R., Alhifthi, N., Almousa, A., Alferayan, T. A., Alrabeeah, K. A., & Abumelha, S. M. (2021). Longitudinal vs Horizontal Capsular Incision! Does it Alter Micro-TESE Outcome. Journal of Infertility and Reproductive Biology, 9(3), 117-122. Retrieved from https://www.dormaj.org/index.php/JIRB/article/view/431
Regular publication process (free of charge)