Background: Microdissection testicular sperm extraction (microTESE) has become the standard procedure in nonobstructive men with azoospermia. Typically, wide exposure incision is always adopted in the procedure to facilitate the identification of dilated seminiferous tubules under the microscope.
Aim: The aim was to compare transverse and longitudinal tunical incision techniques in complex nonobstructive azoospermic patients subjected to microTESE regarding the sperm-retrieval rate.
Patients and Methods: A total of 100 patients having nonobstructive azoospermia were subjected to the following: history taking, general and genital examination, semen analysis, microTESE, and testicular biopsy for histopathology. Bilateral microTESE was done through on one side by longitudinal incision technique and on the other side by transverse incision technique.  Results: Testicular sperm was successfully retrieved in 26% of patients. The sperm-retrieval rate in mixed pathology, hypospermatogenesis, spermatogenic arrest at spermatocyte level, and sertoli cell-only syndrome was 44, 60, 31, and 12.5%, respectively. This study showed no statistically significant difference in sperm retrieval between both techniques (P=0.510).  Conclusion: The microTESE technique does not affect sperm retrieval in challenging instances. This could be explained by the identical exposure of seminiferous tubules between the two techniques. However, follow-up research is required to determine whether the two procedures have fewer adverse effects on testicular parenchyma.