Non obstructive azoospermia (NOA), due to testicular failure, revealed up to 60% of all cases of azoospermia. One of the decisive NOA management is performing testicular sperm extraction (TESE) with success rates approximately 50%, yet a factor for predicting TESE quality is still insufficient. The objective of this work was to assess and develop an alternative outcome predictor of TESE procedure in NOA. To this purpose, a retrospective case series was performed to 31 patients with azoospermia undergone TESE in 2016-2018. Collected data included a clinical history, testicular volume, hormone levels and testicular histology were analyzed following sperm retrieval. The findings resulted in 14 patients had obstructive azoospermia (OA) and 17 patients had NOA. The results showed that all of OA patients had positive sperm retrieval, while NOA patients were 50%. The analyzed data performed that the normal value of testicular size, FSH and the high Johnson score (≥8) were the finest predictor of positive sperm retrieval. In conclusion, the modification of Johnson score may be utilized as a promising predictor of successful or positive surgical sperm retrieval in NOA.