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Journal of Andrology, Vol. 27, No. 4, July/August 2006
Copyright © American Society of Andrology

Perspectives and Editorials

Letter to the Editor

Is TESA Passé?

I respectfully submit that this is inaccurate. TESE is, from a surgical point of view, little more than a testis biopsy, and in my 26 years at our institution doing this in dozens of patients, save for one or two who requested general anesthesia because of perceived testisphobia (sic), I don't recall ever doing a TESE, regardless of whether it was multifocal (sometimes up to 6+ biopsies per testis) or unifocal, under general anesthesia and in an operating suite. In fact, at UCLA it would cost almost as much as many IVF centers charge for ICSI/IVF if I were to do a testis biopsy in the operating suite–and this does not include the surgical fee for the TESE. Cost is therefore one of a number of reasons why TESE is done under local anesthesia in the office setting. With TESE, complete anesthesia of the area, whether unilateral or bilateral, can be obtained by an intradermally injected anesthetic plus a cord block. While a few of our patients undergoing TESE have had a vasovagal reflex which simply responded to intranasal ammonia, we have never lost a testis nor had a complication of the cord block that necessitated any corrective therapy.

I for one have always assumed that those physicians who did TESA did so because they were primarily andrologists and were, therefore, not surgically trained. While this may be true or not, based on the powerful data of these two excellent studies, it seems prudent that those who perform TESA in preference to TESE need to rethink their reasons for ever considering TESA as a method of sperm aspiration, particularly in nonobstructive azoospermia.

Respectfully yours, Jacob Rajfer, MD

Footnotes

DOI: 10.2164/jandrol.06008

References

Hauser R, Yogev L, Paz G, Yavetz H, Azem F, Lessing JB, Botchan A. Comparison of efficacy of two techniques for testicular sperm retrieval in nonobstructive azoospermia: multifocal testicular sperm extraction versus multifocal testicular sperm aspiration. J Androl. 2006; 27: 28 –33.[Abstract/Free Full Text]

Kovai B, Vlaisavljevi V, Relji M. Clinical use of pentoxifylline for activation of immotile testicular sperm before ICSI in patients with azoospermia. J Androl. 2006; 27: 45 –52.[Abstract/Free Full Text]

This Article Full Text (PDF) All Versions of this Article: 27/4/491    most recent Author Manuscript (PDF) Author Manuscript (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Rajfer, J. Search for Related Content PubMed PubMed Citation Articles by Rajfer, J.