Marmar Joel L, Benoff Susan
Division of Urology, Robert Wood Johnson Medical School, Camden, New Jersey, USA.
Hum Reprod. 2005 Aug;20(8):2279-88. doi: 10.1093/humrep/dei027. Epub 2005 Apr 21.
We hypothesized that infertile men with varicoceles have molecular/genetic defects that interact with varicoceles to induce infertility. Studies directly on testis tissue appeared to be a way to link histology, markers for molecular/genetic defects and spermatogenesis, but testis biopsies may induce morbidity. In this report, we present safety and efficacy data on ultrasonically guided, single stick, percutaneous aspiration.
Biopsies were performed on 115 infertile men with varicoceles and five men with obstructive azoospermia. Morbidity was examined by pre- and post-biopsy ultrasound, efficacy by ability of two markers to predict >50% increase in sperm density post-operatively. All patients had three pre- and three post-operative semen analyses.
78.3% of patients had no ultrasonic testicular defects immediately post-biopsy. By 2 months, 100% had no defects. Biopsy markers [testicular cadmium (<0.453 ng/mg tissue) and an intact calcium channel mRNA sequence] predicted >50% increase in sperm density with 82.9 and 90.5% accuracy, respectively.
Ultrasonically controlled, percutaneous aspiration testis biopsies are safe. Specimens so acquired can assist study of molecular/genetic markers associated with spermatogenesis in infertile men with varicoceles. Tissue cadmium level, calcium channel sequence and other markers may predict outcome of varicocele surgery.
我们推测患有精索静脉曲张的不育男性存在分子/基因缺陷，这些缺陷与精索静脉曲张相互作用导致不育。直接对睾丸组织进行研究似乎是一种将组织学、分子/基因缺陷标志物与精子发生联系起来的方法，但睾丸活检可能会引发并发症。在本报告中，我们展示了超声引导下单针经皮穿刺抽吸的安全性和有效性数据。
对115例患有精索静脉曲张的不育男性和5例梗阻性无精子症男性进行活检。通过活检前后的超声检查并发症情况，通过两种标志物预测术后精子密度增加>50%的能力来评估有效性。所有患者术前和术后均进行了三次精液分析。
78.3%的患者活检后立即没有超声可见的睾丸缺陷。到2个月时，100%的患者没有缺陷。活检标志物[睾丸镉（<0.453 ng/mg组织）和完整的钙通道mRNA序列]预测精子密度增加>50%的准确率分别为82.9%和90.5%。
超声控制下的经皮穿刺睾丸活检是安全的。通过这种方式获取的标本有助于研究与患有精索静脉曲张的不育男性精子发生相关的分子/基因标志物。组织镉水平、钙通道序列和其他标志物可能预测精索静脉曲张手术的结果。
