Testicular touch print smear (TPS) is a rapid cytological staining technique that allows detailed evaluation of spermatogenesis from a small piece of testicular tissue, retrieved either via biopsy or procedures like microdissection testicular sperm extraction (mTESE). TPS provides real-time information on sperm yield, helping to determine when to conclude surgery and saving valuable operating room time. Beyond its diagnostic utility, we found that TPS may offer additional clinical value. We explored two potential additional values of TPS: 1. Discrepancies between TPS findings and traditional pathological diagnoses. 2. Preservation of testicular volume and testosterone levels postoperatively.

In this retrospective study, we reviewed patients who underwent two or more mTESE procedures at our institution over the past five years.

A total of 105 cases were analyzed. Changes in testicular size and serum testosterone levels were recorded. No significant postoperative changes were observed in either parameter. Diagnostic discrepancies between TPS and pathology were found in approximately 32% of cases, including 11% where TPS findings were < pathology, and 21% where TPS showed > pathology. TPS < pathology was mainly seen in cases of late maturation arrest (LMA) and hypospermatogenesis. TPS > pathology occurred mostly in Sertoli cell-only syndrome (SCOS) and hypospermatogenesis.

When TPS is used routinely, surgeons tend to target smaller but sperm-dense seminiferous tubules for retrieval, aiding embryologists and helping preserve testicular volume and Leydig cell function. Moreover, TPS provides more detailed information on spermatogenesis compared to conventional pathological slides. By integrating TPS with histopathology, we can obtain a more comprehensive understanding of testicular spermatogenesis.