Longitudinal vs horizontal capsular incision! Does it alter micro-TESE outcome?


  • Hani Albadawe
  • Rizwanul Haque
  • Naif Alhifthi
  • Abdullah Almousa
  • Turki A Alferayan
  • Khalid A Alrabeeah
  • Saad M Abumelha


sperm retrieval, azoospermia, sperm injections, intracytoplasmic, semen analysis


Micro-TESE (testicular sperm extraction), a procedure performed for treatment of non-obstructive
azoospermia (NOA), a leading infertility issue among males globally accounting for about 7% of
male population. Azoospermia is absence of sperms in ejaculate upon semen analysis, 2% of 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 approach, established studies have
identified about 45% to 65% of success retrieving spermatozoa. The objective being identification of
success of both the variants of procedure separately and also of post-operative 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 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 post-operative evaluation, in transverse approach,
sperm were retrieved in 25.29% and for longitudinal approach retrieval was about 19.54%. The success
rate was 48.9% out of 45 procedures in transverse approach and 40.5% out of 42 procedures in 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 in 12.6% of patients. Not much of statistical significance was observed
between the transverse and longitudinal approach in either of the outcomes whether it is success rate or
post-operative complications. Both approaches are influenced by the factors of surgeon expertise and
certain other factors that include pre- and post-operative hormonal therapy, baseline hormonal status
and intracytoplasmic sperm injection (ICSI).