Turek P J, Ljung B M, Cha I, Conaghan J
Department of Urology, University of California San Francisco School of Medicine, San Francisco, California, USA.
J Urol. 2000 Jun;163(6):1709-16.
Although helpful for defining extratesticular obstruction, the testis biopsy offers limited information on nonobstructive azoospermic testes. Guided by diagnostic biopsies, testis sperm extraction procedures fail in 25% to 50% of patients with nonobstructive azoospermia, largely because it is clinically difficult to know where sperm are located. To provide a more complete assessment of spermatogenesis in nonobstructive azoospermic patients and to simplify the confirmation of sperm production in men with obstruction, we use a systematic, fine needle aspiration "mapping" procedure. We summarize the diagnostic findings in a series of azoospermic men.
From 118 azoospermic infertile men (22 with obstructed and 96 with nonobstructed azoospermia) fine needle aspiration data were used to generate location specific, sperm frequency maps for obstructed and nonobstructive azoospermic testes to determine if "sperm rich" locations existed.
Fine needle aspiration map analysis revealed that all aspiration locations from obstructed cases showed sperm. In men with nonobstructive azoospermia, sperm was identified in the right testis in 134 of 652 (20.5%) and in the left testis in 151 of 716 (21.1%) separate aspirations. Rates of sperm detection among various intratesticular sites were not statistically different. In 27.1% of cases the fine needle aspiration map found sperm in men with sperm negative biopsies. The likelihood of heterogeneity in fine needle aspiration sperm findings was 25% within individual nonobstructive azoospermic testes and 19.2% between testis sides. At post-procedure followup of 88 patients (74%), no clinical or surgical complications were observed.
Testis fine needle aspiration mapping is a simple, reliable and informative diagnostic tool in the evaluation of azoospermic infertile men.
睾丸活检虽然有助于定义睾丸外梗阻，但对于非梗阻性无精子症睾丸提供的信息有限。在诊断性活检的指导下，睾丸精子提取程序在25%至50%的非梗阻性无精子症患者中失败，主要是因为临床上很难知道精子的位置。为了更全面地评估非梗阻性无精子症患者的精子发生情况，并简化梗阻性男性精子产生的确认过程，我们采用了一种系统的细针抽吸“定位”程序。我们总结了一系列无精子症男性的诊断结果。
从118例无精子症不育男性（22例梗阻性无精子症和96例非梗阻性无精子症）中，利用细针抽吸数据生成梗阻性和非梗阻性无精子症睾丸的特定位置精子频率图，以确定是否存在“富含精子”的位置。
细针抽吸图分析显示，梗阻性病例的所有抽吸部位均显示有精子。在非梗阻性无精子症男性中，在右侧睾丸的652次单独抽吸中有134次（20.5%）发现精子，在左侧睾丸的716次单独抽吸中有151次（21.1%）发现精子。不同睾丸内部位的精子检测率无统计学差异。在27.1%的病例中，细针抽吸图在活检精子阴性的男性中发现了精子。在个体非梗阻性无精子症睾丸内，细针抽吸精子结果异质性的可能性为25%，在双侧睾丸之间为19.2%。在88例患者（74%）的术后随访中，未观察到临床或手术并发症。
睾丸细针抽吸定位是评估无精子症不育男性的一种简单、可靠且信息丰富的诊断工具。
