Ishikawa Tomomoto, Yamaguchi Kohei, Chiba Koji, Takenaka Atsushi, Fujisawa Masato
Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
J Urol. 2009 Oct;182(4):1495-9. doi: 10.1016/j.juro.2009.06.029. Epub 2009 Aug 15.
Microdissection testicular sperm extraction combined with intracytoplasmic sperm injection is currently used to treat infertility in cases of nonobstructive azoospermia. Even in patients with nonmosaic Klinefelter's syndrome, who usually present with small testes and hypogonadism, the procedure has been done successfully. We assessed serum hormones after microdissection testicular sperm extraction and compared postoperative testicular damage between 46XY males with nonobstructive azoospermia and those with Klinefelter's syndrome.
We retrospectively reviewed the records of 140 men with azoospermia, including 100 46XY males with nonobstructive azoospermia and 40 with nonmosaic Klinefelter's syndrome, who underwent microdissection testicular sperm extraction. Serum follicle-stimulating hormone, luteinizing hormone and testosterone were evaluated before, and 1, 3, 6, 9, 12 and 18 months after surgery.
In 46XY males with nonobstructive azoospermia serum follicle-stimulating hormone during 18 months of followup, and luteinizing hormone 1 and 3 months postoperatively were significantly increased vs baseline. No significant differences were observed in testosterone at any postoperative time point vs baseline. In men with Klinefelter's syndrome who underwent sperm extraction mean testosterone significantly decreased an average of 30% to 35% vs baseline when assessed 1, 3, 6, 9 and 12 months postoperatively. It returned to 75% of the preoperative level after 18 months. In Klinefelter's syndrome cases no significant differences were observed in follicle-stimulating hormone and luteinizing hormone at each postoperative time point.
Hormonal followup after microdissection testicular sperm extraction is recommended, particularly in patients with Klinefelter's syndrome, to prevent the deleterious consequences of hypogonadism.
显微切割睾丸取精术联合卵胞浆内单精子注射目前用于治疗非梗阻性无精子症患者的不育症。即使是患有非嵌合型克兰费尔特综合征的患者，通常表现为睾丸小和性腺功能减退，该手术也已成功实施。我们评估了显微切割睾丸取精术后的血清激素水平，并比较了非梗阻性无精子症的46XY男性与克兰费尔特综合征患者术后的睾丸损伤情况。
我们回顾性分析了140例无精子症男性的记录，其中包括100例非梗阻性无精子症的46XY男性和40例非嵌合型克兰费尔特综合征患者，他们均接受了显微切割睾丸取精术。在手术前以及术后1、3、6、9、12和18个月评估血清促卵泡激素、促黄体生成素和睾酮水平。
在非梗阻性无精子症的46XY男性中，随访18个月期间血清促卵泡激素以及术后1个月和3个月的促黄体生成素与基线相比显著升高。术后任何时间点的睾酮水平与基线相比均未观察到显著差异。在接受取精术的克兰费尔特综合征男性中，术后1、3、6、9和12个月评估时，平均睾酮水平与基线相比平均显著降低30%至35%。18个月后恢复到术前水平的75%。在克兰费尔特综合征病例中，术后各时间点的促卵泡激素和促黄体生成素均未观察到显著差异。
建议在显微切割睾丸取精术后进行激素随访，尤其是在克兰费尔特综合征患者中，以预防性腺功能减退的有害后果。
