Severe testicular atrophy does not affect the success of microdissection testicular sperm extraction.
Severe testicular atrophy does not affect the success of microdissection testicular sperm extraction.
复制标题
DOI：
10.1016/j.juro.2013.07.065
复制
发表时间：
2014-01
影响因子：
6.6
通讯作者：
Schlegel, Peter N.
中科院分区：
文献类型：
--
作者：
Bryson, Campbell F.;Ramasamy, Ranjith;Sheehan, Matthew;Palermo, Gianpiero D.;Rosenwaks, Zev;Schlegel, Peter N.
无精子症和严重睾丸萎缩的男性可能被建议避免精子回收，因为他们认为成功有限。我们评估了重度睾丸萎缩（体积≤2ml）男性的显微解剖睾丸精子提取（micro-TESE）的结果。我们回顾了1127例非阻塞性无精子症患者的记录，他们接受了显微tese，然后进行了卵胞浆内单精子注射。根据平均睾丸体积（mL）将男性分为三组，≤2,> - 10,>10。计算取精率、临床妊娠率和活产率。评估的临床特征包括年龄、卵泡刺激素水平、隐睾病史、Klinefelter综合征、精索静脉曲张和诊断活检的睾丸组织学。56%的男性成功地提取了睾丸精子。睾丸体积≤2、睾丸体积2 ~ 10、睾丸体积10 mL男性的精子回收率（SRR）分别为55%、56%和55%。在取回精子的男性中，三组的临床妊娠率和活产率相似（分别为55.2%、50.0%和47.0%;47.2%、43.0%和42.2%）。在106名平均睾丸体积≤2ml的男性中，与未发现精子的男性相比，获得精子的男性更年轻（31.1岁对35.2岁），并且更有可能患有克氏综合征（82.2%对55.6%）（p < 0.05）。该组男性的Klinefelter综合征患病率高于睾丸bbb2.0 mL的男性（72.6% vs 5.3%, p<0.0001）。年龄小于30岁的Klinefelter综合征患者的SRR（81.8%）高于年龄大于30岁的非Klinefelter综合征患者（33%,p<0.01）。对于睾丸小的男性来说，没有年龄的临界值，超过这个临界值精子就不能被提取。在多变量分析中，较小的年龄是与小睾丸（<2mL）男性成功取精相关的唯一术前因素。在我们的中心，睾丸体积不影响微型tese取精率。对于睾丸体积最小的男性来说，那些患有Klinefelter综合征的年轻男性的精子回收率最高。严重的睾丸萎缩不应成为显微tese的禁忌症。
Men with azoospermia and severe testicular atrophy may be counseled to avoid sperm retrieval due to perceived limited success. We evaluated the outcomes of microdissection testicular sperm extraction (micro-TESE) in men with severe testicular atrophy (volume ≤ 2 mL). We reviewed the records of 1127 men with nonobstructive azoospermia who underwent micro-TESE followed by intracytoplasmic sperm injection. The men were classified into three groups based on average testicular volume (mL), ≤2, >2–10, >10. Sperm retrieval, clinical pregnancy, and live birth rates were calculated. The clinical features evaluated included age, FSH level, history of cryptorchidism, Klinefelter syndrome, varicocele, and testicular histology from diagnostic biopsy. Testicular sperm were successfully retrieved in 56% of the men. Sperm retrieval rates (SRR) in men with testicular volumes of ≤ 2, >2–10, and >10 mL was 55%, 56% and 55% respectively. Of those men who had sperm retrieved, clinical pregnancy and live birth rates were similar in the three groups (55.2%, 50.0%, and 47.0%; and 47.2%, 43.0% and 42.2% respectively). Of the 106 men with average testis volume ≤ 2 mL bilaterally, men who had sperm retrieved were younger (31.1 vs. 35.2 years), and were more likely to have a history of Klinefelter syndrome (82.2% vs 55.6%) compared to those in whom sperm was not found (p < 0.05). Men in this group had a higher prevalence of Klinefelter syndrome than men with testis >2 mL (72.6% vs 5.3%, p<0.0001). Men younger than 30 years with Klinefelter syndrome had a higher SRR (81.8%) compared to men older than 30 without Klinefelter syndrome (33%, p<0.01). There was no cut-point for age beyond which sperm could not be retrieved in men with small testes. On multivariable analysis, younger age was the only preoperative factor associated with successful sperm retrieval in men with small testes (<2mL). Testicular volume does not affect sperm retrieval rates at our center with micro-TESE. For men with the smallest volume testes, those younger men with Klinefelter syndrome had the highest sperm retrieval rates. Severe testicular atrophy should not be a contraindication for micro-TESE.
登录
查看更多内容
影响因子：
6.1
作者：
Sciurano, R. B.;Luna Hisano, C. V.;Solari, A. J.
通讯作者：
Solari, A. J.
影响因子：
23.4
作者：
Bromage, Stephen J.;Falconer, Debbie A.;Payne, Stephen R.
通讯作者：
Payne, Stephen R.
影响因子：
6.7
作者：
Ramasamy, Ranjith;Reifsnyder, Jennifer E.;Schlegel, Peter N.
通讯作者：
Schlegel, Peter N.
影响因子：
6.6
作者：
Ramasamy, Ranjith;Ricci, Joseph A.;Schlegel, Peter N.
通讯作者：
Schlegel, Peter N.
影响因子：
23.4
作者：
Marconi, Marcelo;Keudel, Andreas;Weidner, Wolfgang
通讯作者：
Weidner, Wolfgang