Varicocelectomy outcomes among patients with azoospermia and severe oligasthenoteratozoospermia.

Background: Varicocele is a reversible cause of male infertility. However, there are conflicting data available concerning the benefit of varicocele repair for patients with nonobstructive azoospermia (NOA) and severe oligoasthenoteratozoospermia (OAT). Objective: To address the benefit of varicocelectomy in patients with severe OAT and NOA with regard to their semen parameters and surgical sperm retrieval rate in those who underwent testicular sperm extraction (TESE) or testicular sperm aspiration (TESA). Materials and Methods: This retrospective cohort study was conducted on a sample of 13 patients diagnosed with NOA and severe OAT who underwent varicocelectomy for infertility treatment with no prespecified exclusion criteria. Results: Thirteen patients were enrolled. Five patients were diagnosed with NOA; eight were diagnosed with severe OAT. For improvements in the semen parameters postoperatively, the semen concentration of all patients was significantly increased compared to the preoperative concentration (3.59 ± 10.0.8 vs. 0.25 ± 0.31, P = 0.02) and the remaining parameters were unchanged. Regarding sperm retrieval, three patients underwent TESE and two patients underwent TESA, in which all had positive results. Conclusion: Varicocele repair was found to improve the semen parameters in patients with NOA and severe OAT and produced a successful surgical sperm retrieval rate in all patients who underwent TESA or TESE.

Effects of first year COVID-19 pandemic on urology practice in three major Arab Countries: Sub-Analysis of a survey by Arab association of urology research group.

BACKGROUND AND OBJECTIVES: The World Health Organization (WHO) declared the coronavirus disease-19 (COVID-19) pandemic on March 11, 2020. The health care system faced tremendous challenges in providing ethical and high-quality care. The impact of COVID-19 on urological practices varied widely worldwide, including in Arab countries. This study aimed to compare the influence of the COVID-19 pandemic on urology practice in Egypt, the KSA, and the UAE during the first year of the pandemic. METHODS: This sub-analysis assessed the demographics and COVID-19's effects on urological practice in terms of adjustments to hospital policy, including outpatient consultations, the management of elective and urgent surgical cases, and the continuation of education across the three countries. The availability of personal protective equipment (PPE) and urologists' emotional, physical, and verbal intimidation during COVID-19 were also compared. RESULTS: Regarding the impact on hospital policy, consultations replaced by telemedicine were significantly higher in the KSA (36.15%), followed by the UAE (33.3%), then Egypt (10.4%) (P = 0.008). Elective cases requiring ICU admission were 65.1% in Egypt, 45.2% in the KSA, and 58.2% in the UAE and were performed only in high-risk patients. PPE was freely available in 20.8% of the Egyptian hospitals compared to 83.3% in the KSA and 81.8% in the UAE. Online courses were significantly higher in Egypt (70.8%), followed by the UAE (53%) and the KSA (41.7%) (P = 0.02). Emotional intimidation was higher than verbal intimidation, representing 80%, 75.9%, and 76% in the UAE, KSA, and Egypt, respectively. CONCLUSION: This sub-analysis outlined significant hospital policy changes across the three Arab countries. Exposure to emotional, verbal, and physical intimidation was observed. The development of teleconsultations and online platforms for educational purposes was observed.

Prevalence of Hypogonadism Symptoms Among Males With Hypothyroidism at a Tertiary Hospital: A Cross-Sectional Study.

Background  Hypogonadism is a condition in which the body's ability to produce sex hormones is reduced. Androgen deficiency and hypothyroidism are similar in many symptoms, and the coexistence of the two conditions is common. The aim of this study is to explore the prevalence of hypogonadism symptoms in male patients diagnosed with primary hypothyroidism. Methods  This cross-sectional study was conducted at  King Abdulaziz Medical City  in Riyadh,  Saudi Arabia, with a sample size of 120 adult male patients with primary hypothyroidism. Data collection primarily relied on one instrument, namely, the Androgen Deficiency in Aging Males (ADAM) questionnaire, which was translated into Arabic and validated by previous researchers. Results  A total of 120 adult males with hypothyroidism completed the ADAM questionnaire. Out of the 120 patients, 67.5% had a positive screen for hypogonadism. Among patients who had hypogonadism symptoms on the questionnaire, 81% had a BMI above 25, 69% were older than 40, and 65% were smokers. Conclusion  Hypogonadism symptoms are common in male patients with primary hypothyroidism. Among patients with primary hypothyroidism, increasing age and being overweight added to the likelihood of having hypogonadism symptoms.

Perceptions of testicular cancer and self-examination in the general population of Saudi Arabia.

Background: Although testicular cancer (TC) is the most common malignancy in males between the ages of 18 and 50 years, little effort has been made to increase public awareness about TC and testicular self-examinations (TSEs). Therefore, the aim of this study was to assess the level of awareness of TC and TSEs in the Saudi population. Materials and Methods: This study was conducted using a structured questionnaire distributed online through social media platforms. The questionnaire consisted of 11 questions related to TC and TSE. All relevant data were moved into an Excel sheet, and data analyses were carried out using SPSS. Results: A total of 849 responses were received. The proportion of respondents who knew any information about TC was 26.5%, with media or the Internet being the most common sources of information (16.3%). In addition, 5.5% of respondents knew how to perform a TSE, although only 4% actually performed TSEs. The patient age group was an independent significant predictor of this knowledge, with a P = 0.031. Conclusions: These findings suggest that there is a low level of public awareness and knowledge of TC and TSE in Saudi Arabia, and further efforts should be focused on raising public awareness.

Varicocelectomy for scrotal pain: Is it effective?

Introduction: Varicocelectomy is the prevailing management of scrotal pain secondary to varicocele. However, the literature is controversial on this topic. Some data showed that pain may persist after the surgery even if the varicocele is not detected postoperatively. Objectives: The objectives of the study were to identify the effect of varicocelectomy in patients with chronic scrotal pain, to report the association between the clinical grade and postoperative pain resolution, and to identify the need for a secondary procedure after varicocelectomy to control the pain. Materials and Methods: This was a retrospective study of 47 patients who underwent varicocelectomy between March 2016 and December 2018. Results: Postoperatively, the pain totally resolved after surgery in 64.3% of patients with scrotal pain; it improved in 21.4%, 11.9% have persistent pain, and the pain got worse in only 2.4%. Our study showed 100% complete resolution or improvement with Grade I, 85.7% in Grade II, and 81.3% in Grade III. In addition, all patients who underwent bilateral varicocelectomy had pain that either completely resolved or improved postoperatively. On the other hand, all patients who had persistent pain or pain worsening postoperatively had unilateral varicocelectomy. An additional intervention for postoperative pain control was needed in only 14% of patients, 7% of them underwent embolization, 4.7% had a cord block, and 2.3% were sent to a pain clinic. Conclusion: Varicocelectomy offers good outcomes in most patients with varicocele-related scrotal pain. The most significant predictor for success was low grade and bilaterality. However, there is a subset of patients whose symptoms will not improve postoperatively. Careful preoperative counseling and expectation management are crucial when discussing surgical options for those patients.

Malignant testicular tumors in children: overview on 10 years of Saudi Cancer Registry.

BACKGROUND/OBJECTIVE: The aim of this study was to identify epidemiological and histopathological patterns of pediatric testicular tumor (TT) in Saudi population over 10 years. METHODS: Retrospective data extracted from the Saudi Cancer Registry for Saudi children diagnosed with TT from 2008 to 2017. The data collected included patient's factors as age, year of diagnosis, survival status, and tumor factors as basis of diagnosis, origin of the tumor, histopathological group and subtype, and tumor behavior, stage, and laterality. RESULTS: A total of 115 patients with a median age of 14 (IQR 1.5-17) were included. The primary tumor site was a normal descended testis in 98.3% (115). Yolk sac tumor was the most common 28.2% (33), followed by embryonal carcinoma in 27.4% (32) and mixed germ-cell tumors in 23.1% (27). Kaplan-Meier analysis revealed significant association between survival and the stage of the tumor (p = 0.002). However, there was a lack of significant association between survival and age groups, histopathological groups, and histopathological subtypes (p = 0.541, p = 0.609, and p = 0.733, respectively). The overall mortality rate of TT 5.2% with all deaths caused by non-seminomatous germ-cell tumor diagnosed with stage 3. CONCLUSIONS: The median age of the patients was 14 years. Yolk sac tumors were the most common while testicular choriocarcinomas were the least in incidence. No increase in the incidence of TT was seen and the mortality rate over the 10-year period was 5.2%. Shorter survival was associated with higher tumor stage.

Is routine re-imaging for high-grade renal injury needed? Retrospective analysis of 1500 abdominal trauma patients from a tertiary care trauma center over 11 years.

INTRODUCTION AND AIM: The AUA and EAU guidelines recommend re-imaging in high-grade renal trauma, regardless of the clinical findings. The aim of this study was to assess the impact of re-imaging on the overall management and outcomes in these patients. METHODS: The trauma registry of our tertiary care Level-1 trauma center was reviewed from January 2007 till October 2018. Out of 1536 patients with abdominal trauma, 174 patients with isolated renal injury were identified. Renal injuries were classified based on the AAST classification. Variables retrieved were demographics, renal injury grade, presence of urinoma, repeated imaging findings, and intervention after initial and repeated imaging. RESULTS: Low-grade injury was found in 78.7% (137/174) compared to 21.3% (37/174) with high-grade injury. The majority (n = 136) of low-grade patients were managed conservatively except one patient with Grade III injury required angioembolization after initial imaging. Of the high-grade patients, 31/37 were treated conservatively except 6/37 patients required surgical intervention after initial imaging. Following re-imaging, only one patient required surgical intervention in the form of insertion of a drainage tube for a hematoma, which was possibly infected. The existence of urinoma (5 patients) or hematoma (47 patients) was not associated with significantly higher rate of intervention (p values: 0.717 and 0.138, respectively). No significant association was noted between hematoma size and rate of intervention (p value = 0.055). CONCLUSION: Re-imaging for high-grade renal injuries could be limited to the presence of urinary extravasation in initial imaging or the presence of clinical deterioration such as pain, fever or decrease in hemoglobin level.

AUA-recommended Antibiotic Prophylaxis for Primary Penile Implantation Results in a Higher, Not Lower, Risk for Postoperative Infection: A Multicenter Analysis.

PURPOSE: Our aim was to determine if the AUA-recommended prophylaxis (vancomycin + gentamicin alone) for primary inflatable penile prosthesis surgery is associated with a higher infection risk than nonstandard regimens. MATERIALS AND METHODS: We performed a multicenter, retrospective study of patients undergoing primary inflatable penile prosthesis surgery. Patients were divided into those receiving vancomycin + gentamicin alone and those receiving any other regimen. A Cox proportional-hazards model was constructed adjusted for major predictors. A subgroup analysis to identify the appropriate dosage of gentamicin was also performed. RESULTS: A total of 4,161 patients underwent primary inflatable penile prosthesis placement (2,411 received vancomycin + gentamicin alone and 1,750 received other regimens). The infection rate was similar between groups, 1% vs 1.2% for standard vs nonstandard prophylaxis. In the multivariable analysis, vancomycin + gentamicin (HR: 2.7, 95% CI: 1.4 to 5.4, P = .004) and diabetes (HR: 1.9, 95% CI: 1.03 to 3.4, P = .04) were significantly associated with a higher risk of infection. Antifungals (HR: 0.08, 95% CI: 0.03 to 0.19, P < .001) were associated with lower risk of infection. There was no statistically significant difference in infection rate between weight-based gentamicin compared to 80 mg gentamicin (HR: 2.9, 95% CI: 0.83 to 10, P = .1). CONCLUSIONS: Vancomycin + gentamicin alone for antibiotic prophylaxis for primary inflatable penile prosthesis surgery is associated with a higher infection risk than nonstandard antibiotic regimens while antifungal use is associated with lower infection risk. A critical review of the recommended antimicrobial prophylactic regimens is needed. Prospective research is needed to further elucidate best practices in inflatable penile prosthesis antimicrobial prophylaxis.

Classical Seminoma With Secondary Undescended Testis in an Elderly Patient: An Incidental Finding With a Penile Fracture.

Cryptorchidism is a common condition among children; however, it is rare in adults and is associated with an increased risk of malignancy. The development of secondary undescended testes is recognized as a complication following inguinal surgeries such as hernia repair and orchidopexy. Herein, we describe the case of a 64-year-old male with a known past surgical history of right indirect inguinal hernia repair complaining of penile swelling. The patient was diagnosed with a penile fracture, and a genital examination further revealed a right undescended testis. The patient underwent penile fracture repair and right orchiectomy. Histopathology examinations showed classic seminoma. These findings show that the position of each testis should always be documented before, during, and after inguinal hernia repair due to the increased risk of undescended testis. Histopathological confirmation is necessary for such patients so that malignancy can be identified in its early stages and cured subsequently.

Testicular cancer among Saudi adults: Hands on a nationwide Cancer Registry over 10 years.

Background/objective: Testicular cancer (TC) is one of the most curable solid malignancies affecting young adults. The objective of this study was to identify factors affecting survival of Saudi adults who were diagnosed with testicular cancer over 10 years. Methods: This was a retrospective study with data extracted from the Saudi Cancer Registry for Saudi Adults diagnosed with TC from 2008 to 2017. We collected demographic information, including age, marital status, region of residency, year of diagnosis, and the survival status. In addition, the tumor factors included the basis of diagnosis, the origin of the tumor, histopathological group and subtype, and tumor behavior, stage, and laterality were collected. Results: A total of 869 patients were included, with a median age of 30 (IQR: 25-38). The highest percentage of the cases was 37.5% (326) in the Central region, followed by the Western region 24.6% (214). The primary site of the tumor was the testis 96.9% (842), 3.1% (27) in the undescended testis. The histopathological examination revealed seminoma in 44.8% (389), 33.5% (291) mixed germ cell tumor, 8.4% (73) embryonal carcinoma, 6.1% (53) teratoma, 2.6% (23) yolk sac tumor, 1.6% (14) choriocarcinoma, 0.3% (3) Leydig cell tumor, and 2.6% (23) sarcomas. Kaplan-Meier analysis revealed significant association between survival and the age groups (p = 0.001), histopathology group (p 0.04), histopathology subtypes (p = 0.01), and the stage of the tumor (p < 0.001). Conclusions: A notable increase in the incidence of TC among Saudi adults was seen, with a mortality rate of 5.4% over a period of 10 years. Longer survival was associated with age groups, seminomatous germ cell tumor, and lower tumor stage.

Trends of Acute Renal Colic During COVID-19 Lockdown: An Experience From Saudi Arabia.

Introduction The COVID-19 pandemic represents an unprecedented challenge for healthcare systems around the world. Saudi Arabia was one of the first countries to experience a lockdown and postponement of elective surgical procedures. The objective of this study was to assess the trends of acute renal colic presenting to our emergency department. Methods This retrospective study targeted all patients who presented with acute renal colic during the lockdown period (March 23, 2019 to June 20, 2019). Patients' and stone data were collected. The patient's data included age, gender, BMI, and comorbidities. Stones' data included stone size, location, side, evidence of obstruction and UTI, and planned and conducted management. Results A total of 137 patients were identified; 92 (67.2%) patients were males with a mean age of 44 ± 16 years. Positive history of urolithiasis was reported in 47 (34.3%). The most common initial investigation was non-contrast CTs (93.4%). The majority of patients had a stone size of < 10 mm (93%) and ureteric stones (81.2%). A total of 32 patients (32.4%) had evidence of UTI and 63.4% had evidence of obstruction. Most of the patients (73.7%) were offered medical expulsive therapy (MET). Only 2.2% did not receive the planned management. Conclusion The observed pattern shows that the management during the lockdown did not differ from the original recommendations. This could be due to the fact that most patients had stone sizes between 5 and 10 mm and consequently were managed by METs. Larger data need to be conducted to provide concrete evidence. Such data are relevant to provide a clear guide for management and to establish protocols for emergency lockdown situations.

Chronic pelvic pain syndrome symptoms significantly affect medical students' well-being.

Aims: This study aims to determine the prevalence of chronic pelvic pain syndrome (CPPS) symptoms among male-medical students in Riyadh, Saudi Arabia. Settings and Design: It is a cross-sectional study at King Saudi Bin Abdulaziz University for Health Sciences, College of Medicine at Riyadh, Saudi Arabia. Subjects and Methods: A total of 300 male medical students were given a hardcopy questionnaire to be filled anonymously that includes demographic characteristics, several questions regarding the health status, habits of the participants, and the National Institutes of Health Chronic Prostatitis Symptom Index for evaluating CPPS symptoms. Statistical Analysis Used: SPSS (v21) was used for the analysis. Qualitative data presented by frequencies and percentages and quantitative data presented by median and interquartile range (Q1 to Q3). The Chi-square test and binary logistic regression were used to assess the relationship between the outcome variables with demographical data. Results: In total 300 male medical students were surveyed, 245 medical students returned the questionnaire giving a response rate of 81.6%. The prevalence of CPPS symptoms among all participants was 57.9%. Majority of the participants does not have any associated medical/psychological conditions 152 (62%). Students with irritable bowel syndrome (IBS) or/and anxiety have statistically significant association with CPPS symptoms (P < 0.05). A total of 23% of students with CPPS reported being impaired with their quality of life (QOL), while 77% are satisfied. Conclusions: The prevalence of CPPS symptoms among male medical students is high. Anxiety, IBS, and lack of activity might be associated with CPPS symptoms, which have a significant negative impact on the QOL. For the future direction, a large-scale global study should be conducted to link the effects of CPPS symptoms on male medical students well-being.

Recurrent urethral stricture with dual lumen managed by a single stage dorsal Onlay buccal mucosal graft Urethroplasty: a case report.

Urethral stricture is defined as any abnormal narrowing throughout the entire length of the male urethra. Anterior urethral stricture is the most common site which accounts for more than 90% of cases in developed countries. One of the possible long-term outcomes of urethral stricture treatment is stricture recurrence. Refractory urethral strictures to initial management present surgical challenges to the reconstructive surgeon. It has been reported in the literature that buccal mucosal grafts in complex anterior urethral strictures have lately become a well-established management modality for bulbar and penile urethral strictures. Here, we are presenting an interesting case of a patient with a dual lumen urethra due to recurrent urethral stricture.

Intraoperative diagnosis of seminoma in a man with cryptorchidism and Klinefelter Syndrome planning for m-TESE: A case report.

Undescended testes are more likely to undergo malignant transformation than normally descended testes. We present the case of a 33-year-old male smoker who had been suffering from primary infertility for 4 years. This patient had bilateral undescended testes and a frozen section specimen revealed seminoma. In this report, we discussed how important it is to use a combination of different diagnosis modalities to reach a diagnosis.

How did the first year of the COVID-19 pandemic affect urology practice in Arab countries? A cross-sectional study by the Arab Association of Urology research group.

OBJECTIVE: The aim of this study was to assess of the effect of coronavirus disease 2019 (COVID-19) pandemic on urology practice in the Arab world during the first year of the crisis. METHODS: An Internet-based questionnaire was created and sent out via email to members of the Arab Association of Urology (AAU) using 'Google Forms'. The survey assessed participants' demographics in terms of age, gender, country of origin, type of practice and position. Impacts of COVID-19 on urological practice were assessed in terms of the changes in hospital policies regarding consultations, and elective and emergency surgical cases. Moreover, impacts of COVID-19 on urologists were assessed. RESULTS: A total of 255 AAU members across 14 Arab countries (Emirates, Egypt, Saudi Arabia, Iraq, Jordan, Algeria, Kuwait, Yemen, Qatar, Lebanon, Libya, Oman, Sudan and Syria) completed the survey; 4% were female urologists. Consultations at outpatient clinics were closed or restricted to emergency cases or replaced by telemedicine in almost 15%, 40% and 25% of hospitals, respectively. Elective surgeries were stopped or reduced to under 25% of surgical capacity in >10% and about 25% of hospitals, respectively. Almost 90% (228) reported changes in the policy for emergency theatres. Nearly 65% of hospitals offered preoperative COVID-19 testing to patients and 50% of hospitals provided personal protective equipment (PPE) to their urologists. Of 99% (253) who reported a change in urological education, 95% relied on online webinars. About 56% of respondents had their own private practice, of whom 91% continued private practice during the crisis. About 38% of participants reported exposure to intimidation (75% emotional, 20% verbal and 5% physical). CONCLUSION: The COVID-19 pandemic resulted in major changes in hospitals' policies regarding outpatient consultations, elective and emergency operative cases, and the shift to telemedicine. Arab urologists have been facing major challenges either in both the governmental or the private sectors, and some of them were exposed to emotional, verbal and even physical intimidation.

Foley catheter erosion through bladder wall causing intraperitoneal bladder injury: a case report.

Bladder perforation due to indwelling catheters is regarded to be a very rare incident. Most cases of catheter-induced rupture were in patients with chronic catheterization due to chronic bladder diseases. An 80-year-old male with neurogenic bladder on chronic catheterization presented to the emergency room with abdominal pain and anuria. On CT, the tip of the catheter was eroding through the bladder into the peritoneum. The patient underwent a laparotomy with adhesiolysis. The tip of the Foley catheter was seen eroding through the bladder dome. A new open tip catheter was inserted per urethra to prevent the catheter tip from eroding again through the bladder wall. Bladder erosion or rupture is associated with high morbidity and mortality. Our case demonstrates the deleterious effects of chronic catheterization and the need for a high level of suspicion when dealing with such cases.

Saudi patient knowledge and awareness regarding smoking as a risk factor for urological diseases.

AIM: Our aim was to evaluate Saudi patient knowledge and awareness regarding smoking as a risk factor for bladder cancer, kidney cancer, and erectile dysfunction (ED). SETTINGS AND DESIGN: This quantitative cross-sectional study was conducted across three major tertiary hospitals in Riyadh, the capital city of Saudi Arabia. MATERIAL AND METHODS: A self-administered questionnaire was distributed to 539 patients in the urology outpatient clinic. STATISTICAL ANALYSIS: Data were analyzed using the Statistical Package for the Social Studies 21.0. For descriptive statistics, the frequency was calculated for all study variables. Chi-squared test was used for categorical variables. P < 0.05 was considered statistically significant. RESULTS: A total of 539 urological patients completed the questionnaire. There were 460 (85.4%) male and 79 (14.6%) female respondents. Only 60.9%, 41.2%, and 36.9% of participants were aware that smoking was a risk factor for ED, kidney cancer, and bladder cancer, respectively. CONCLUSIONS: The knowledge and awareness were low among urological patients regarding smoking as a risk factor for urological diseases.

Ureteropelvic junction obstruction causing a spontaneous collecting system rupture: A case report and review of the literature.

Stones are the most common cause of collecting system ruptures. There are few reported cases of a ruptured collecting system without an underlying pathological cause. We report a case of a 15-year-old female patient who presented with left flank pain that was associated with nausea and vomiting. Computed tomography revealed a large, left retroperitoneal fluid collection, which was associated with severe hydronephrosis without an obvious pathological cause. The patient was treated with the insertion of a left double-J stent, and a retrograde pyelography confirmed the cessation of extravasation. At follow up, she was treated surgically with left robotic-assisted pyeloplasty without complications.

Primary Renal Synovial Sarcoma Presenting as Haemorrhagic Shock: A Rare Presentation.

Primary synovial sarcoma (PSS) of the kidney is considered the rarest type of all renal sarcomas with specific chromosomal translocation t (X; 18) (p11.2; q11.2). We report the case of a 65-year-old man with no medical conditions who presented to the emergency department with sudden severe right flank pain associated with haemodynamic instability and haemorrhagic shock. Computed tomography (CT) of the abdomen and pelvis revealed a right renal mass. A right open radical nephrectomy was performed. Histopathology revealed a monophasic synovial sarcoma. The patient received six cycles of docetaxel and gemcitabine as adjuvant chemotherapy. No sign of recurrence was seen on a follow-up CT urogram. This rare tumour often presents atypically, and clear guidelines regarding appropriate treatment are lacking. Our case showed that treatment with docetaxel/gemcitabine after an open radical nephrectomy is promising.

Effect of hormonal manipulation using clomiphene citrate prior to microdissection testicular sperm retrieval.

INTRODUCTION: Microdissection Testicular Sperm Extraction (micro-TESE) is a surgical method used for retrieving sperm from men with non-obstructive azoospermia. Clomiphene citrate (CC) is a selective estrogen receptor modulator (SERM) that stimulates luteinizing hormone (LH) and follicle-stimulating hormone (FSH) production. It is believed that treating patients with CC prior to micro-TESE increases the chance of sperm retrieval. METHODS: This retrospective study was conducted in a tertiary care center in Riyadh, Saudi Arabia and included all patients who underwent Micro-TESE from August 2015 to November 2018. Data related to the pre-surgery hormonal levels, testicular volume, and associated genetic abnormalities were collected. chi-square and t-test were used to compare variables. A p-value of less than 0.05 was considered significant. RESULTS: A total of 122 patients were included in this study, with 30.0% (n=37) treated with CC. The overall sperm retrieval rate was 44.3%. Micro-TESE results were not statistically affected by age, testosterone levels, Klinefelter syndrome, or taking CC. However, higher testicular volumes and lower LH and FSH levels had more positive micro-TESE results. CONCLUSION: In conclusion, Micro-TESE results were not affected by CC, age or testicular volume.