Combined Trifocal and Microsurgical Testicular Sperm Extraction Is the Best Technique for Testicular Sperm Retrieval in "Low-Chance" Nonobstructive Azoospermia
Combined Trifocal and Microsurgical Testicular Sperm Extraction Is the Best Technique for Testicular Sperm Retrieval in "Low-Chance" Nonobstructive Azoospermia
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DOI：
10.1016/j.eururo.2012.03.004
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发表时间：
2012-10-01
期刊：
影响因子：
23.4
通讯作者：
Weidner, Wolfgang
中科院分区：
文献类型：
--
作者：
Marconi, Marcelo;Keudel, Andreas;Weidner, Wolfgang
背景资料：对于“低机会”非梗阻性无精子症（NOA）患者的最佳睾丸精子提取（TESE）技术，目前尚无共识。目的：通过个体内比较，确定在显微镜辅助和非显微镜辅助下使用睾丸三个部位的精子回收率（显微外科TESE [M-TESE]）。设计、设置和参与者：65例表现为睾丸体积小的低机会NOA患者系列（12.4 IU/l）接受了双侧三焦点-TESE + M-TESE（每个睾丸四次活检）。精子回收采用三焦点-TESE（上、中、下睾丸极）在中间切口有和没有显微镜辅助下进行。结果测量和统计分析：评价评价的小管数量、平均精子发生评分和精子回收率，以确定回收位置和显微镜的使用。采用Friedman和科克伦Q检验确定统计学差异。接受者工作特征曲线用于分析血清FSH和睾丸体积作为术前预后因素。结果和局限性：使用组合技术的精子回收成功率为66.2%，这意味着至少有一个小管含有细长精子细胞的患者百分比在三焦点和M-TESE组合中最高（p < 0.01），表明该技术对于低机会NOA患者是最佳的。单独使用M-TESE和三焦点-TESE并没有明显更好。M-TESE的平均精子发生评分（给出了与所有小管相关的具有细长精子细胞的小管数量）显著高于传统TESE（p < 0.01），表明使用显微镜采集的组织质量上级。这些结果受到使用“一个”精子细胞/小管的“成功”定义的限制。术前，高血清FSH和低睾丸体积并不排除成功的精子retrieval.Conclusions：三焦点和M-TESE的组合是最好的技术，以达到低机会NOA患者的高精子回收率。(C)2012年欧洲泌尿外科协会。由Elsevier B出版。版权所有© 2016
Background: There is no consensus for the best testicular sperm extraction (TESE) technique in patients with "low-chance" nonobstructive azoospermia (NOA).Objective: To determine sperm retrieval rates in an intraindividual comparison using three locations of the testicle with and without the assistance of a microscope (microsurgical TESE [M-TESE]).Design, setting, and participants: A series of 65 patients with low-chance NOA presenting with low testicular volume (12.4 IU/l) underwent trifocal-TESE plus M-TESE bilaterally (four biopsies per testis).Intervention: Sperm retrieval was performed as trifocal-TESE (upper, middle, and lower testicular pole) with and without the assistance of a microscope in the middle incision.Outcome measurements and statistical analysis: The number of evaluated tubules, the mean spermatogenetic scores, and the sperm retrieval rates were evaluated to determine retrieval locations and the use of the microscope. The Friedman and Cochrane Q tests were applied to determine statistical differences. Receiver operating characteristic curves were used for the analysis of serum FSH and testicular volume as preoperative prognostic factors.Results and limitations: The sperm retrieval success of 66.2% using the combined technique, meaning the percentage of patients with at least one tubule containing elongated spermatids, was the highest in the combination of trifocal-and M-TESE (p < 0.01), indicating this technique as optimal for patients with low-chance NOA. M-TESE and trifocal-TESE alone were not significantly better. The mean spermatogenetic score giving the number of tubules with elongated spermatids in relation to all tubules was significantly higher in M-TESE versus conventional TESE (p < 0.01), indicating the superior quality of the tissue harvested using the microscope. These results are limited by the definition of "success" using "one" spermatid/tubule. Preoperatively, high serum FSH and low testicular volumes did not exclude successful sperm retrieval.Conclusions: The combination of trifocal-and M-TESE is the best technique to reach high sperm retrieval rates in patients with low-chance NOA. (C) 2012 European Association of Urology. Published by Elsevier B. V. All rights reserved.