Significant prognostic factor of immunohistochemical HER-2 expression using initial prostate biopsy specimens with M1b prostate cancer.

BACKGROUND: We examined whether human epidermal growth factor-2(HER-2) overexpression could be a useful marker of outcome after hormone therapy in patients with M1b prostate cancer (PC). SUBJECTS AND METHODS: The subjects were 102 patients who were diagnosed with M1b PC at Aichi Medical University Hospital. HER-2 expression was determined by immunohistochemical (IHC) staining using initial needle biopsy specimens for diagnosis. The results were classified into four grades (0, 1+, 2+, 3+), and scores of 1+ or greater were considered overexpression and defined as positive. RESULTS: The results showed a rating of 0 in 72 subjects, 1+ in 10, 2+ in 14, and 3+ in 6; 30 subjects (29.4%) were classified as HER-2 positive. Comparison of clinical data of HER-2 positive and negative subjects obtained at baseline revealed many of the subjects with high-grade tumors by Gleason score were HER-2 positive (P = 0.030). The prostate-specific antigen (PSA) relapse was observed in 76 subjects and cause-specific death occurred in 44. A significant difference was observed only in the item HER-2 (negative vs. positive) by multivariate Cox proportional hazard analysis. The 5-year PSA relapse-free rate was 0% in subjects with HER-2 positive (26/30), and 43.9% in subjects with HER-2 negative (50/72, P = 0.0192). The 5-year cause-specific survival rate was 40.9% in subjects with HER-2 positive (30/102), and 67.3% in subjects with HER-2 negative (72/102, P = 0.0301). CONCLUSION: HER-2 overexpression as determined by IHC staining using needle biopsy specimens for diagnosis with M1b PC is a significant prognostic factor for PSA relapse after hormone therapy and unfavorable outcome.

Contrast-enhanced ultrasound using a time-intensity curve for the diagnosis of renal cell carcinoma.

OBJECTIVE: • To evaluate the usefulness of contrast-enhanced ultrasound (CEUS) for the diagnosis of renal cell carcinoma by employing a time-intensity curve (TIC). PATIENTS AND METHODS: • From May 2008 to October 2009, CEUS was performed prior to surgery in 30 patients with renal masses. • In all, 10 of the 30 patients had cystic renal masses. The final diagnoses of all patients were pathologically confirmed. Contrast enhancement as a function of time was measured in two (tumour or solid component of cystic lesions and normal parenchyma) regions of interest (ROI) and TICs were obtained. • The time to the contrast enhancement peak (TTP), intensity change from the baseline to peak (ΔI) and ΔI/TTP of the tumour and the normal parenchyma were measured from the TIC. RESULTS: • Pathological diagnoses were renal cell carcinoma in 30 patients. • The TTP of the cancer was shorter than that of the normal parenchyma in all cases (6.0 ± 2.0 vs 10.4 ± 3.0 s; P < 0.0001). • The ΔI did not differ between the cancer and normal parenchyma [21.3 ± 5.9 vs 20.9 ± 7.0 decibels (db); P= 0.68]; the ΔI/TTP of the cancer was significantly higher than that of the normal parenchyma (3.9 ± 1.4 vs 2.2 ± 0.94 db/s; P < 0.0001). • TIC patterns of solid cancer and cystic cancer were very similar. CONCLUSIONS: • An objective and quantitative diagnosis of renal cell carcinoma by CEUS using a second-generation ultrasound contrast agent can be made by employing a TIC. • The TIC patterns of solid and cystic cancers were very similar, despite their morphological and vascular differences. • CEUS using TIC is a promising tool in the diagnosis of cystic renal cancer.

Treatment of upper urinary tract stones with extracorporeal shock wave lithotripsy (ESWL) Sonolith vision.

BACKGROUND: The aim was to retrospectively assess the results of treatment of upper urinary tract stones with the Sonolith vision manufactured by EDAP, and purchased in 2004. METHODS: The subjects were 226 Japanese patients who underwent extracorporeal shock wave lithotripsy (ESWL) alone as an initial treatment and could be followed up for at least 3 months, selected from 277 candidate patients who underwent this therapy between 2004 and 2006. Treatment effect was evaluated by kidney, ureter, and bladder X-ray or renal ultrasonography at 1 and 3 months after treatment. A stone-free status or status of stone fragmentation to 4 mm or smaller was considered to indicate effective treatment. RESULTS: At 3 months after treatment, the stone-free rate was 69.4% and the efficacy rate was 77.4% for renal stones, while these rates were 91.5 and 93.3%, respectively for ureteral stones. Assessment of treatment effect classified by the location of stones revealed a stone-free rate of 94.6% and an efficacy rate of 94.6% for lower ureteral stones (4.0 mm or smaller, 1 subject; 4.1-10.0 mm, 31 subjects; 10.1-20.0 mm, 5 subjects: number of treatment sessions, 1 or 2 sessions [mean: 1.03 sessions]). Complications of this therapy included renal subcapsular hematoma and pyelonephritis in 1 case each. CONCLUSIONS: ESWL with the Sonolith vision manufactured by EDAP produced a treatment effect equivalent to those achieved with other models of ESWL equipment. ESWL seems to be an effective first-line treatment also in patients who have lower ureteral stones 10 mm or larger but do not wish to undergo TUL, if measures such as suitable positioning of the patient during treatment are taken.

Association between gefitinib and hemorrhagic cystitis and severely contracted bladder: a case report.

BACKGROUND: Gefitinib remains an excellent treatment option for patients with a variety of cancers, including non small cell lung cancer (NSCLC). However, clinicians must be aware of the potential of gefitinib to cause an inflammatory reaction in the skin, lungs and bladder. CASE PRESENTATION: We present a case on hemorrhagic cystitis and severely contracted bladder in a patient with NSCLC on gefitinib. CONCLUSIONS: Further studies are needed to substantiate the association of gefitinib therapy with hemorrhagic cystitis and contracted bladder.

A rare case of metastatic renal carcinoid.

BACKGROUND: Carcinoid is an endocrine cell tumor with low-grade atypia, which is generally a low-grade malignant cancer with a good prognosis. Metastatic renal carcinoid is even rarer than primary carcinoids. CASE PRESENTATION: We present our experience of a patient with metastatic renal carcinoid from the gastrointestinal tract. CONCLUSIONS: The carcinoid tumor of the kidney in our patient, who had a history of liver metastasis from rectal carcinoid, was considered metastatic based on the pathological findings.

Long-term results and management of ureteral transitional cell carcinoma using the holmium: YAG laser via rigid-ureteroscopy.

The standard operative procedure for ureteral transitional cell carcinoma is nephrouterectomy with partial cystectomy at the affected ureteral orifice. However, nephron-sparing surgery and endoscopic surgery and management have become common practice for low-grade and low-stage cases. We investigated the follow-up results of patients who underwent endoscopic surgery using the holmium:YAG laser, and evaluated its treatment effect. The patients were 4 men and 3 women aged from 68 to 87 years (mean: 74.7 years). Two were imperative cases and 5 were elective cases. The tumor size ranged from 8 to 25 mm (mean: 15.4 mm). Hydronephrosis was not found in any case, and urinary cytology was negative in all cases. Biopsy revealed 5 cases of grade 1, and 2 of grade 2. A Versa Pulse Select 80 laser generator, a 365-microm slim line laser fiber, and a rigid ureteroscope with 8F-point diameter were used. A 6F double J catheter was placed postoperatively for 3 weeks. Pulse energy was set at 0.5-1.0 J (mean: 0.8 J) with a frequency of 10 Hz. The total amount of energy was 0.9-11.22 KJ (mean: 2.89 KJ) and the operation time including ureteral stent placement was 20-97 min (mean: 66 min). Neither urinary tract perforation nor ureteral stricture associated with laser irradiation was observed. The postoperative follow-up period ranged from 23-88 months (mean: 67.8 months). Patients underwent urinary cytological examination once a month, and cystoscopy, retrograde pyelography and urethroscopy once every 3 months for 2 years, then once every 6 months thereafter. One patient developed tumor recurrence 23 months after surgery and received another laser treatment, but no recurrence has been observed in the other 6 patients (85.7%). Transurethral endoscopic surgery and management using the holmium:YAG laser is safe and effective nephron-sparing surgery for ureteral transitional cell carcinoma, and good long-term treatment results can be expected even in elective cases if the indications are carefully selected.

Potential for HER-2/neu molecular targeted therapy for invasive bladder carcinoma: comparative study of immunohistochemistry and fluorescent in situ hybridization.

Analysis of HER-2/neu expression in invasive bladder carcinoma was performed in order to evaluate the potential for molecular targeted therapy targeting HER-2. The subjects were 40 patients who were pathologically diagnosed with invasive transitional cell carcinoma of the bladder (pT2 to pT4). A Hercep test kit was used to detect HER-2 expression, and a Path Vysion kit was used for gene amplification. On immunohistochemical (IHC) staining, the primary tumors were HER-2 positive in 17 patients (17/40, 42.5%). According to the classification of grade, one Grade 2 patient (1/3) and 16 Grade 3 patients (16/37) were positive (P=0.99). According to the classification of stage, 12 pT2 patients (12/22, 54.5%), 2 pT3 patients (2/13, 15.3%), and 3 pT4 patients (3/5, 60%) were positive (P=0.55). Lymph node metastasis was found in 10 patients, and 3 pN2 patients were HER-2 positive (3/6, 50%) (P=0.32). A statistically significant difference was observed between HER-2-positive primary tumors and metastatic lymph nodes (P=0.02). In fluorescent in situ hybridization (FISH), HER-2/neu gene amplification was detected in the primary tumors in 5 patients (5/40, 12.5%). In all these patients, IHC staining was determined as 3+. Lymph node metastasis was found in 3 pN2 patients (3/6) (P=0.32), and in these patients with HER-2/neu gene-amplified metastatic lymph nodes, the primary tumors were also positive for gene amplification (P=0.02). In these cases, IHC staining was 3+ as well. The concordance rate of IHC-positive cases with cases positive for HER-2/neu gene amplification in FISH was 12.5% (5/40), and the concordance rate of IHC 3+ and gene amplification was 71%. This result suggests that, at present, patients who may potentially benefit from molecular targeted therapy targeting HER-2/neu for invasive bladder carcinoma should be identified by gene amplification analysis using FISH in IHC 3+ patients. In addition, it suggested that efficacy of molecular targeted therapy can be expected even for patients with metastatic lymph nodes as long as the primary tumors are positive for HER-2 expression.

Solitary brain metastasis from pT1, G3 bladder cancer.

Brain metastasis from bladder cancer occurs rarely. Particularly, solitary brain metastasis is very rare in patients who have never received systemic chemotherapy. We encountered a patient who underwent transurethral resection of bladder tumor and bacillus Calmette-Guérin bladder instillation for pT1, G3 bladder cancer accompanied by carcinoma in situ, and subsequently revealed solitary brain metastasis after 34 months while neither cystoscopy nor urine cytology revealed abnormalities during this period. To our knowledge, our experience of solitary brain metastasis from pT1 bladder cancer is the second case in the world.

Retrograde vasal sperm aspiration in anejaculatory patients with spinal cord injury.

Aim: This paper describes our experience with retrograde vasal sperm aspiration (ReVSA) in anejaculatory patients with spinal cord injury. Methods: We performed 11 vasal sperm aspiration procedures on eight patients presenting with neurogenic anejaculation associated with spinal cord injury at our institute between 2004 and 2007. This procedure was conducted under local anesthesia with a spermatic block. A 24G needle was inserted into the vas in a retrograde fashion. Sperm-washing medium was gently injected into the proximal vas several times and collected. Aspirated sperm was cryopreserved for intracytoplasmic sperm injection. Results: Adequate motile sperm was obtained from all patients. All couples underwent intracytoplasmic sperm injection; clinical pregnancies were achieved in eight cases (two ongoing pregnancies and the births of six healthy babies). Conclusion: Retrograde vasal sperm aspiration is a reliable method for the consistent recovery of sperm of sufficient quality to afford a high pregnancy rate and in sufficient quantity to permit cryopreservation of excess sperm for future use. (Reprod Med Biol 2008; 7: 115-118).

Potential for molecular targeted therapy of HER-2/neu for invasive bladder cancer: examination of gene amplification by fluorescence in situ hybridization.

Analysis of HER-2/neu gene amplification by fluorescence in situ hybridization was performed in 40 patients with invasive bladder cancer in order to evaluate the potential for molecular targeted therapy of HER-2 as a tailor-made treatment for patients with invasive bladder cancer. This study included 40 patients seen at the Aichi Medical University Hospital from January 2001 to December 2004 and were pathologically diagnosed with invasive transitional cell carcinoma of the bladder (pT2-pT4). The PathVysion kit was used to evaluate the status of HER-2/neu gene amplification, and a signal ratio > or =2.0 was considered positive for HER-2/neu gene amplification. In primary foci 5 patients (12.5%) were positive for HER-2/neu gene amplification. According to the classification of grade and stage, no statistically significant difference was observed. Lymph node metastasis was found in 10 patients, and 3 patients (30%) were positive for HER-2/neu gene amplification. In the patients with HER-2/neu gene-amplified metastatic lymph nodes, primary foci were also positive for gene amplification, showing a statistically significant difference. This study indicates that 12.5% of patients with invasive bladder cancer may benefit from molecular targeted therapy of HER-2, and that molecular targeted therapy can be expected to be effective even for patients with lymph node metastases as long as their primary foci are positive for HER-2/neu gene amplification.

Potential for molecular-targeted therapy targeting human epidermal growth factor receptor-2 for invasive bladder cancer.

Expression of human epidermal growth factor receptor-2 (HER-2/neu or HER-2) oncoprotein in invasive bladder cancer was examined by immunohistochemical staining in order to evaluate the potential for molecular-targeted therapy targeting HER-2 as a tailor-made treatment for patients with invasive bladder cancer. This study included 40 patients who were examined at Aichi Medical University Hospital and were pathologically diagnosed with invasive transitional cell carcinoma of the bladder (pT2 to pT4). Immunohistochemical staining using a Hercep test kit was performed to detect HER-2 expression, which was classified into four levels from 0 to 3+ by two experienced pathologists, with 2+ and 3+ determined as positive. HER-2 staining in the primary tumor was determined as 0 in 9 (22.5%) patients, 1+ in 14 (35%), 2+ in 10 (25%), and 3+ in 7 (17.5%), resulting in 17 (17/40, 42.5%) HER-2-positive patients. According to the classification of grade, one (1/3, 33.3%) grade 2 patient and 16 (16/37, 43.2%) grade 3 patients were HER-2 positive (p=0.99). According to the classification of stage, 12 (12/22, 54.5%) pT2 patients, 2 (2/13, 15.3%) pT3 patients, and 3 (3/5, 60%) pT4 patients were HER-2 positive (p=0.05). Lymph node metastasis was found in 10 patients, and 3 (3/6, 50%) pN2 patients were HER-2 positive (p=0.32). There was a statistically significant difference between patients with HER-2-positive primary tumors and those with HER-2-positive metastatic lymph nodes (p=0.02). This study suggested that 42.5% of patients with invasive bladder cancer may benefit from molecular-targeted therapy targeting HER-2, and that the efficacy of molecular-targeted therapy can be expected even for patients with lymph node metastases as long as their primary tumors are HER-2 positive.

Primary adenocarcinoma of the ureter: report of a case.

The patient was a 66-year-old man who presented with asymptomatic hematuria. Left hydronephrosis was observed on drip infusion pyelography (DIP), and retrograde pyelography (RP) was performed because the image of the ureter was poor. On RP, stenosis was observed in the left ureter at the L5 vertebral level. The same findings were obtained by antegrade pyelography in combination with nephrostomy. A white-colored tumor was observed at the site ofstenosis by flexible pyeloscopy, and biopsy was performed. Adenocarcinoma was identified by histopathological examination. Total left renal nephroureterectomy was performed after its diagnosis as primary adenocarcinoma of the ureter (T2, NO, MO). To our knowledge, this is the 12th case reported in Japan.

Differential profiling analysis of proteins involved in anti-proliferative effect of interferon-alpha on renal cell carcinoma cell lines by protein biochip technology.

Interferon-alpha (IFN) is widely used for the treatment of progressive renal cell carcinoma (RCC), but its effective response rate is only about 15%. New biomarkers of RCC contributing to the effective IFN treatment are needed to establish a sensitivity test for evaluating if the IFN is effective or not against RCC. All the proteins expressed in the IFN-susceptible and -resistant RCC cell lysates were analyzed by surface enhanced laser desorption ionization (SELDI) mass spectrometry using ProteinChip technology and their different protein expression were detected by the comparison of the profiles between them. We detected the following candidate markers that exhibited peak shifts: a) in the IFN-susceptible cell lines, a candidate marker with a molecular weight of 5,688 Da was detected on a hydrophobic (H4) chip: b) in the IFN-resistant cell lines, candidate markers each with a molecular weight of 8,049, 3,157, 3,993, and 8,959 Da were detected on strong anion exchange (SAX2, pH 9.0, two types) chips, H4 chip, and weak cation exchange (WCX, pH 9.0) chips, respectively. IFN treatment produced no weight increase in these four proteins, and c) candidate marker with a molecular weight of 1,623 Da that was expressed in both cell lines after the IFN treatment was detected on the H4 chip. These data suggest that the ProteinChip system is very useful in identifying proteins showing unique peaks in the RCC cell lines with different IFN susceptibility, and the comparison of these proteins measured in RCC cell lysates may help to identify the IFN sensitivity. Furthermore, the discovery of a susceptibility and or a inhibitory factor may eventually lead to the development of a novel drug targeting the respective factor for the improvement of anticancer chemotherapy.

Thymidine phosphorylase expression as a prognostic marker for predicting recurrence in primary superficial bladder cancer.

No prognostic marker for predicting recurrence in primary superficial bladder cancer has been established. The aim of this study was to investigate the expression levels of thymidine phosphorylase (TP) by enzyme-linked immunosorbent assay (ELISA) and the immunohistological localization of TP in primary superficial bladder cancer tissue to assess its association with tumor recurrence and stage progression as well as the pathological parameters of the tumor. TP expression in cancer tissues from 77 patients was measured by sandwich-type ELISA. Clinicopathological factors and the clinical prognosis were examined in relation to the expression levels of TP. To clarify the clinicopathological implication of TP localization in primary superficial bladder cancer tissue, the immunohistochemically determined TP expression was assessed for histological grades 1-3. The TP expression in primary superficial bladder cancer significantly increased with the histological grade and stage. The TP expression in patients with a shift to invasive cancer was significantly higher than in those without invasive cancer. Patients with low TP expression had a significant longer postoperative tumor-free period than those with high TP expression (P=0.011). High TP expression was an independent prognostic factor for tumor recurrence (P=0.0441). Strong immunoreactivity for TP was observed in the cytoplasms of tumor cells and vascular endothelial cells. This study suggests that elevated TP expression may be a prognostic marker for predicting recurrence in primary superficial bladder cancer, and that high TP expression may be associated with the marked proliferation of tumor cells and increased vascular endothelial cells, showing strong immunoreactivity for TP.

Is neuroendocrine cell differentiation detected using chromogranin A from patients with bone metastatic prostate cancer a prognostic factor for outcome?

We evaluated the usefulness of overexpression of neuroendrocrine (NE) cell differentiation determined by immunohistochemical staining for chromogranin A (Cg A) in diagnostic needle biopsy specimens of bone metastatic prostate cancers. A total of 50 patients diagnosed as having bone metastatic prostate cancer were studied. The period of observation was between 6.9 and 79.4 months (median 48.7 months). Cg A was detected by immunostaining using the labeled streptavidin biotin method. Cg A-positivity was defined as the presence of immunostained cells in 10% or more of the tumor. All statistical analyses were carried out using the Statistical Package for Social Sciences Software, version 10.0 for Windows. Eleven patients (22%) were classified into the Cg A-positive group. There were no significant differences in clinical data between the Cg A-positive and Cg A-negative groups. The 5-year cause-specific survival rate was 34.1% for the Cg A-positive group and 55.2% for the Cg A-negative group (p=0.3763). The 3-year non-recurrence rate was 9.1% for the Cg A-positive group and 35.9% for the Cg A-negative group, and this difference was significant (p=0.0253). The 3-year cause-specific survival rates after recurrence were 38.4% and 42.3% respectively (p=0.8125). We consider that NE cell differentiation of the primary tumor in cases of bone metastatic prostate cancer is not a prognostic factor for outcome.

Clinical experience of ureteroscopic treatment for ureteral transitional cell carcinoma using the Holmium:YAG laser.

The standard operative method for ureteral transitional cell carcinoma is nephrouterectomy with partial bladder excision of the ureteral orifice of the affected bladder. However, a conservative kidney operation and endoscopy are now being performed for low grade, low stage cases. We performed an operation using a Holmium: YAG laser, and examined its safety and efficacy. The patients were four men, and 1 woman aged from 68 to 87 (mean 78) years. There were 2 imperative cases (1 solitary kidney case, and 1 high-risk case), and 3 elective cases. The tumor size ranged from 8 to 25 (mean 14) mm. Urinary cytology was negative in all cases, and the tumors were pathologically diagnosed as grade 1 atypism on biopsy. A VersaPulse Select 80 laser generator, a 365 micro m SlimLine laser fiber, and an 8F rigid ureteroscope were used. A 6F double J catheter was indwelt for three weeks after the surgery. The pulse energy setting was 0.5-1.0 J, and the frequency was 10 Hz. The total amount of energy was 1.02-11.22 (mean 3.56) kJ, and the operation time was 20-97 (mean 50) min including the time for indwelling a ureteral stent. Neither urinary tract perforation nor ureteral stricture caused by the laser irradiation were observed. The patients have been followed by examining urine cytology once a month, and cystoscopy, retrograde pyelography, and urethroscopy once every 3 months. No recurrence has been observed as of 4-20 (mean 10) months postoperatively. Transurethral endoscopic resection using a Holmium: YAG laser is a safe and effective therapy for ureteral transitional cell carcinoma while preserving kidney and a good treatment outcome can be expected even in elective cases.

Effective treatment of bladder tumor-bearing mice by direct delivery of bleomycin using electrochemotherapy.

We investigated the cytotoxicity on the combination of bleomycin (BLM) with electric pulses against transplanted bladder tumors in nude mice. Loading with high-voltage electric pulse after injection of BLM was associated with a decrease in tumor size; tumor size became smaller and disappeared 8 days after the treatment. Such complete regression was achieved with one treatment using BLM of one-tenth the lethal dose (LD(50)) combined with electric pulses. On day 20, regrowth was observed at a much slower rate than at lower concentrations of BLM. Pathological examinations of the tumor tissues after treatment revealed disruption of the nucleus in the exposed tissues on day 2. Furthermore, a decrease in number of the stained nuclei and cytoplasmic lysis were observed on day 4. These results showed that electric pulses was an effective tool to deliver drugs into bladder tumor cells and an effective treatment method for bladder tumors.

Percutaneous ureteral incision with a small-caliber flexible ureteroscope.

OBJECTIVES: We reviewed the results of percutaneous ureteral incisions for ureteroenteroanastomotic stricture using the holmium laser. METHODS: We performed this procedure through a 6.9-F flexible ureteroscope on 3 ureters in 3 patients. Balloon dilation was not necessary prior to insertion of the ureteroscope. The stricture was incised with the holmium laser with a 200-microm fiber through the working channel of the ureteroscope. After completion of the incision, a 12-F double-J ureteral stent was left in situ for 6 weeks. Thereafter, patients were followed with repeated renal scans, ultrasound, or both, and excretory urography at 3- to 6-month intervals. RESULTS: The stricture resolved completely in all cases at an average follow-up of 25.3 months (16 to 32 months). CONCLUSIONS: Although the number of treated patients was small, percutaneous ureteral incision for ureteroenteroanastomotic stricture using the holmium laser was associated with a good outcome. We recommend this procedure be considered initially because it is less invasive and has a favorable outcome.

Clinical experience of vasoepididymostomy using a triangulation technique.

Background: Although the number of patients receiving vasoepididymostomies is gradually increasing, these individuals are limited in the recent advanced assisted reproductive technology (ART) era. A novel technique involving vasoepididymostomy with epididymal tubular invagination has been reported. We attempted to define the results of this method and to compare them with the conventional end-to-side technique in patients with suspected epididymal obstruction and no previous history of vasectomy. Methods and Results: Eight eligible triangulation end-to-side vasoepididymostomy procedures performed on five azoospermic patients exhibiting either unilateral or bilateral epididymal obstruction are described. The overall patency rate following operation was 100% (five of five). Two pregnancies were achieved by natural intercourse and one was accomplished via artificial insemination. A single pregnancy was obtained with an intracytoplasmic sperm injection using frozen-thawed sperm collected during the operation. Conclusion: Vasoepididymostomy, using the triangulation technique for epididymal obstruction, resulted in an earlier patency in all patients. This method may afford advantages when compared with the conventional end-to-side approach; however, larger subject populations are required in order to assess further the efficacy of this procedure. In addition, long-term follow up is necessary. (Reprod Med Biol 2003; 2: 101-104).

Testicular sperm extraction using microdissection for non-obstructive azoospermia.

Background : Men presenting with non-obstructive azoospermia (NOA) caused by germinal failure can now be treated in some cases using testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI). However, TESE is a blind procedure that does not identify the focal sperm-producing areas until excision of the testicular tissue. Microdissection TESE, which is the only method available for obtaining excised dilated seminiferous tubules under the operating microscope, improves sperm yield with minimal tissue excision in NOA patients. Methods and Results : We performed this procedure on 16 NOA patients. All subjects underwent a microdissection TESE on the right testis, and triple biopsy on the left testis in consecutive fashion in order to compare the efficacy of microdissection TESE with that of a standard biopsy. Although dilated seminiferous tubules were presented in all patients, spermatozoa were retrieved in only a single patient by microdissection TESE. Furthermore, spermatozoa could not be identified by standard biopsies. Conclusion : In this series, microdissection TESE did not contribute to spermatozoa recovery in NOA patients. Further study is needed in order to arrive at a reliable assessment of microdissection TESE relative to a standard multiple biopsy in cases of NOA. (Reprod Med Biol 2002; 1: 31-34).