Nowroozi Mohammad Reza, Ahmadi Hamed, Ayati Mohsen, Jamshidian Hasan, Sirous Ali
Department of Urology, Imam-Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Indian J Urol. 2012 Jan;28(1):37-42. doi: 10.4103/0970-1591.94954.
Sperm recovery by testicular fine-needle aspiration (TESA) has resulted in variable sperm retrieval rate (SRR) and is generally considered inferior to open biopsy (testicular sperm extraction [TESE]).
To develop a predictive model for SRR by TESA and to identify factors associated with comparable SRR between TESA and TESE.
Single-center controlled cross-sectional study on 450 infertile men with nonobstructive azoospermia.
Clinical, paraclinical, and histological information of patients were gathered. All patients underwent both TESA and TESE in a single operation. Predictors of SRR by TESA were identified, and the accuracy of TESA in predicting the outcome of TESE was determined.
Categorical and continuous variables were compared using independent t test and -chi-square test. Logistic regression model was applied to develop a predictive model for SRR by TESA. Receiver Operating Characteristics (ROC) curve analysis was used to determine the accuracy of TESA in predicting TESE outcome.
Sperm retrieval rate for TESA and TESE was 41.8 and 50.9%, respectively (P = 0.04). Age, duration of infertility, testis volume, luteinizing hormone, prolactin, and testosterone did not differ between patients with and without mature sperm in TESA samples. Serum follicular-stimulating hormone (FSH) < 15 IU/l (Exp (B) = 4.8, 95% CI: 1.4-18.5; P = 0.001) and histology of hypospermatogenesis (Exp (B) = 6.4, 95% CI: 2.1-27.4; P < 0.001) were predictors of SRR by TESA. In patients with FSH < 15 IU/l (57.4% versus 59.5%; Area under the curve (AUC) = 0.907) and testicular histology of hypospermatogenesis (68.0% versus 70.5%; AUC = 0.890), the SRR by TESA was predictive of SRR by TESE.
Serum FSH and testicular pathology were predictors of SRR by TESA. Patients with FSH < 15 IU/l and/or testicular pathology of hypospermatogenesis had comparable SRR by TESA versus TESE.
经睾丸细针抽吸术（TESA）获取精子的回收率存在差异，且一般认为其低于开放性活检（睾丸精子提取术[TESE]）。
建立TESA精子回收率（SRR）的预测模型，并确定与TESA和TESE具有可比SRR相关的因素。
对450例非梗阻性无精子症不育男性进行单中心对照横断面研究。
收集患者的临床、辅助检查及组织学信息。所有患者在一次手术中同时接受TESA和TESE。确定TESA的SRR预测因素，并确定TESA预测TESE结果的准确性。
采用独立t检验和卡方检验比较分类变量和连续变量。应用逻辑回归模型建立TESA的SRR预测模型。采用受试者工作特征（ROC）曲线分析确定TESA预测TESE结果的准确性。
TESA和TESE的精子回收率分别为41.8%和50.9%（P = 0.04）。TESA样本中有成熟精子和无成熟精子的患者在年龄、不孕持续时间、睾丸体积、黄体生成素、催乳素和睾酮方面无差异。血清卵泡刺激素（FSH）< 15 IU/l（Exp(B)=4.8，95%CI：1.4 - 18.5；P = 0.001）和生精低下的组织学表现（Exp(B)=6.4，95%CI：2.1 - 27.4；P < 0.001）是TESA的SRR预测因素。在FSH < 15 IU/l的患者中（57.4%对59.5%；曲线下面积[AUC]=0.907）和生精低下的睾丸组织学患者中（68.0%对70.5%；AUC = 0.890），TESA的SRR可预测TESE的SRR。
血清FSH和睾丸病理是TESA的SRR预测因素。FSH < 15 IU/l和/或生精低下的睾丸病理患者，TESA与TESE的SRR具有可比性。
