Repeat and Redo Microdissection Testicular Sperm Extraction (Micro-TESE) in Non-Obstructive Azoospermia: A Narrative Review
4 affiliations
- 1Urology Department, Ioannina University, 45500 Ioannina, Greece
- 23rd Urology Department, Athens University, 12462 Athens, Greece
- 31st Urology Department, Aristotle Thessaloniki University, 54635 Thessaloniki, Greece
- 4Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago 683-8504, Tottori, Japan
Abstract
Microdissection testicular sperm extraction (micro-TESE) is the standard surgical approach for sperm retrieval in men with non-obstructive azoospermia (NOA). However, further procedures may be required either after successful retrieval to support additional intracytoplasmic sperm injection cycles or as salvage treatment following initial failure. This narrative review evaluates outcomes of repeat micro-TESE after previous success and redo micro-TESE after failure, focusing on sperm retrieval rates (SRRs), predictors of success, and strategies proposed to optimize outcomes before reoperation. Repeat procedures following successful retrieval generally show high SRRs, with one large series reporting rates of 73.9–92.5% at subsequent attempts; however, these estimates reflect progressively selected populations and should not be interpreted as independent per-attempt probabilities. In contrast, redo micro-TESE after initial failure achieves sperm retrieval in approximately 10–21% of cases in most series, although higher rates have occasionally been reported. Previous retrieval outcome and testicular histopathology appear most informative for counselling, whereas serum FSH, testicular volume, genetics, and the interval between procedures have inconsistent predictive value. Hormonal pretreatment may modify the intratesticular environment, but evidence for improved redo retrieval remains limited and heterogeneous. Antioxidant therapy is biologically plausible but has not been adequately evaluated in this setting. Technical factors, including the adequacy of the initial procedure, surgical expertise, and laboratory processing, may also influence outcomes. Prospective controlled studies with standardized reporting are needed to define optimal patient selection and management before repeat or redo micro-TESE.
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BibTeX
@article{douvli2026repeat,
title = {{Repeat and Redo Microdissection Testicular Sperm Extraction (Micro-TESE) in Non-Obstructive Azoospermia: A Narrative Review}},
author = {Erriketi Douvli and Athanasios Zachariou and Ioannis Giannakis and Sotirios Koukos and Aris Kaltsas and Harikleia Maria Sofikiti and Michail Baltogiannis and Fotios Dimitriadis and Suichi Morizane and Nikolaos Sofikitis},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15208088},
url = {https://www.mdpi.com/2077-0383/15/20/8088},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Repeat and Redo Microdissection Testicular Sperm Extraction (Micro-TESE) in Non-Obstructive Azoospermia: A Narrative Review
AU - Erriketi Douvli
AU - Athanasios Zachariou
AU - Ioannis Giannakis
AU - Sotirios Koukos
AU - Aris Kaltsas
AU - Harikleia Maria Sofikiti
AU - Michail Baltogiannis
AU - Fotios Dimitriadis
AU - Suichi Morizane
AU - Nikolaos Sofikitis
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15208088
UR - https://www.mdpi.com/2077-0383/15/20/8088
AB - Microdissection testicular sperm extraction (micro-TESE) is the standard surgical approach for sperm retrieval in men with non-obstructive azoospermia (NOA). However, further procedures may be required either after successful retrieval to support additional intracytoplasmic sperm injection cycles or as salvage treatment following initial failure. This narrative review evaluates outcomes of repeat micro-TESE after previous success and redo micro-TESE after failure, focusing on sperm retrieval rates (SRRs), predictors of success, and strategies proposed to optimize outcomes before reoperation. Repeat procedures following successful retrieval generally show high SRRs, with one large series reporting rates of 73.9–92.5% at subsequent attempts; however, these estimates reflect progressively selected populations and should not be interpreted as independent per-attempt probabilities. In contrast, redo micro-TESE after initial failure achieves sperm retrieval in approximately 10–21% of cases in most series, although higher rates have occasionally been reported. Previous retrieval outcome and testicular histopathology appear most informative for counselling, whereas serum FSH, testicular volume, genetics, and the interval between procedures have inconsistent predictive value. Hormonal pretreatment may modify the intratesticular environment, but evidence for improved redo retrieval remains limited and heterogeneous. Antioxidant therapy is biologically plausible but has not been adequately evaluated in this setting. Technical factors, including the adequacy of the initial procedure, surgical expertise, and laboratory processing, may also influence outcomes. Prospective controlled studies with standardized reporting are needed to define optimal patient selection and management before repeat or redo micro-TESE.
SN - 2077-0383
ER -