Lania C, Grasso M, Fortuna F, De Santis L, Fusi F
Department of Urology, Institute H. S. Raffaele, Milan, Italy.
Arch Esp Urol. 2006 Apr;59(3):313-6. doi: 10.4321/s0004-06142006000300020.
Male infertility caused by irreparable obstructive azoospermia is widely treated with MESA (Microsurgical Epididymal Sperm Aspiration) or TESE (Testicular Sperm Extraction) or PESA (Percutaneous Epididymal Sperm Aspiration) followed by an Intracytoplasmatic Spermatozoa Injection (ICSI). For each procedures are claimed advantages and disadvantages. Aim of this work is to describe our technique (OESA) for sperm retrieval reporting the results.
From 1998 to 2003 153 sperm retrieval procedures in azoospermic patients were performed. The technique consists in a small (1 cm.) surgical incision of scrotal wall under local or spinal anaesthesia. After inspecting the intrascrotal component to record the status of the epididymis and of the testicle, epididymal sperm aspiration was performed in the most appropriate site with 18 gauge needle. The aspirated spermatozoa were used immediately after aspiration not being permitted in our Institute cryopreservation. When no sperms were found TESE was performed.
In 78 cases aspiration from epididymis was successful (OESA). In the other patients (75) TESE was performed. Higher count of spermatozoa were retrieved in all cases of OESA. Pregnancy rate was 26.6% for OESA and 6.4% for TESE. No complications occurred.
This technique is very simple and easy allowing to obtain the advantages of microsurgical techniques (mainly choice of the most appropriate site of aspiration and immediate haemostasis if needed) with minimal invasivity (avoiding epididymal surgical incision). Moreover if OESA does not allow sperm extraction is possible to perform immediately TESE.
由无法修复的梗阻性无精子症导致的男性不育，广泛采用显微外科附睾精子抽吸术（MESA）、睾丸精子提取术（TESE）或经皮附睾精子抽吸术（PESA），随后进行卵胞浆内单精子注射（ICSI）治疗。每种手术都有其声称的优缺点。本研究的目的是描述我们用于获取精子的技术（开放式附睾精子抽吸术，OESA）并报告结果。
1998年至2003年，对无精子症患者进行了153次获取精子的手术。该技术包括在局部或脊髓麻醉下，在阴囊壁做一个小（1厘米）的手术切口。在检查阴囊内结构以记录附睾和睾丸的状态后，用18号针头在最合适的部位进行附睾精子抽吸。抽吸到的精子在抽吸后立即使用，本研究所不允许进行冷冻保存。当未发现精子时，则进行睾丸精子提取术。
78例附睾抽吸成功（OESA）。其他患者（75例）进行了睾丸精子提取术。所有OESA病例获取的精子数量都更多。OESA的妊娠率为26.6%，睾丸精子提取术为6.4%。未发生并发症。
该技术非常简单易行，能够获得显微外科技术的优势（主要是选择最合适的抽吸部位，并在需要时立即止血），同时创伤最小（避免附睾手术切口）。此外，如果OESA无法获取精子，可以立即进行睾丸精子提取术。
