Clinical comparison of conventional testicular sperm extraction and microdissection techniques for non-obstructive azoospermia.
Clinical comparison of conventional testicular sperm extraction and microdissection techniques for non-obstructive azoospermia.
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DOI：
10.4021/jocmr542w
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发表时间：
2011-05-19
期刊：
影响因子：
--
通讯作者：
Haddad Y
中科院分区：
文献类型：
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作者：
Ghalayini IF;Al-Ghazo MA;Hani OB;Al-Azab R;Bani-Hani I;Zayed F;Haddad Y
我们比较了显微切割睾丸精子提取术（显微切割TESE）和传统TESE在非梗阻性无精子症（NOA）患者中的疗效，并将阳性精子回收率与某些变量相关：卵泡刺激素（FSH）和黄体生成素（LH）水平，睾丸体积和组织学。对行显微切割TESE（n = 65）或常规TESE（n = 68）的NOA患者的精子回收率（SRR）进行了比较，并与不同的变量相关。显微切割TESE的SRR（56.9%）显著高于常规TESE（38.2%）。SRR与睾丸体积增大或FSH水平降低呈正相关。使用任一技术均未观察到替吉奥或催乳素水平对SRR的影响。常规和显微切割TESE分别在84%和92.9%的精子发生障碍患者中回收精子（P = 0.3）。在成熟停滞的情况下，SRR分别为27.3%和36.4%（P = 0.6）。在支持细胞综合征（SCOS）病例中，SRR分别为6.2%和26.9%（P = 0.03）。两组患者均未发生重大手术并发症，无患者需要术后激素替代治疗性腺功能减退症。与传统TESE相比，显微切割TESE的SRR成功率明显高出两倍。对于NOA患者，不存在可靠的术前精子恢复预后因素。显微解剖TESE在睾丸萎缩、高FSH浓度或可预测高FSH浓度的SCOS的情况下似乎是可行的。显微切割TESE;取精术;非梗阻性无精子症;组织学; FSH浓度;睾丸测量
We compared the efficacy of microdissection testicular sperm extraction (microdissection TESE) and conventional TESE in patients with non-obstructive azoospermia (NOA) and related the positive sperm recovery to certain variables: follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels, testicular volume and histology. Sperm retrieval rates (SRR) in patients with NOA who underwent microdissection TESE (n = 65) or conventional TESE (n = 68) were compared and related to the different variables. SRR by microdissection TESE (56.9%) was significantly higher than conventional TESE (38.2%). There was a positive relation between the SRR and increased testicular volume or decreased FSH levels. No effect of Testosterone or Prolactin levels on SRR by using either technique was observed. Sperm were recovered from those with hypospermatogenesis in 84% and 92.9% by conventional and microdissection TESE, respectively (P = 0.3). In cases of maturation arrest the SRR was 27.3% and 36.4%, respectively (P = 0.6). In cases of Sertoli-cell-only syndrome (SCOS) the SRR was 6.2% and 26.9%, respectively (P = 0.03). No major operative complications occurred in any patient in either group, and no patient required post-operative hormone replacement to treat hypogonadism. Microdissection TESE significantly had twice better probability of success of SRR when compared to conventional TESE. No secure pre-operative prognostic elements of sperm recovery exist for NOA patients. Microdissection TESE appears to be recommendable in cases of atrophied testicles, high FSH concentration, or when SCOS with high FSH concentration can be predicted. Microdissection TESE; Sperm retrieval; Non-obstructive azoospermia; Histopathology; FSH concentration; Orchidometry