Kalsi Jas S, Shah Paras, Thum Yau, Muneer Asif, Ralph David J, Minhas Suks
Frimley Health Foundation Trust, Berkshire, UK.
Imperial College, London, UK.
BJU Int. 2015 Sep;116(3):460-5. doi: 10.1111/bju.12932. Epub 2015 Jun 3.
To assess the outcome of micro-dissection testicular exploration sperm extraction (m-TESE) as a salvage treatment in men with non-obstructive azoospermia (NOA) in whom no sperm was previously found on single/multiple TESE or testicular sperm aspiration (TESA).
In all, 58 men with NOA underwent m-TESE. All the patients had previously undergone either single/multiple TESE or TESA with no sperm found. All the patients underwent an m-TESE using a standard technique. Serum follicle-stimulating hormone (FSH), testosterone and histopathological diagnosis were examined as predictive factors for sperm recovery. All patients underwent preoperative genetic screening. One patient was found to have an azoospermic factor c (AZFc) micro-deletion and five were diagnosed with Kleinfelter's syndrome.
The mean (range) patient age was 39.0 (26-57) years. Spermatozoa were successfully retrieved in 27 men by m-TESE (46.5%). The mean (range) FSH level was 19.4 (1.6-58.5) IU/L. There was no correlation in age (mean age retrieved 38.1 years, not retrieved 39.7 years, P = 0.38), FSH levels (mean FSH retrieved 21.4 IU/L, not retrieved 17.7 IU/L, P = 0.3) and the ability to find sperm by m-TESE. However, there was a significant difference in testosterone levels and sperm retrieval (mean testosterone retrieved 14.99 nmol/L, not retrieved 11.39 nmol/L, P < 0.05). Patients with a diagnosis of Sertoli-cell-only (SCO) syndrome [14/35 (40%)] and maturation arrest [four of 11 (36%)] had lower sperm retrieval rates than those in the hypospermatogenesis group [nine of 12 (75.0%)] (P < 0.05). There were no significant complications after m-TESE.
In men with NOA who have undergone previous attempts at sperm retrieval with negative results, a salvage m-TESE offers a significant chance of finding sperm even in SCO syndrome. There does seem to be a correlation between preoperative testosterone levels and the ability to successfully find sperm.
评估显微解剖睾丸探查取精术（m-TESE）作为非梗阻性无精子症（NOA）男性挽救性治疗方法的效果，这些男性在之前的单次/多次睾丸切开取精术（TESE）或睾丸精子抽吸术（TESA）中均未发现精子。
共有58例NOA男性接受了m-TESE。所有患者之前均接受过单次/多次TESE或TESA且未发现精子。所有患者均采用标准技术进行m-TESE。检测血清促卵泡生成素（FSH）、睾酮水平及组织病理学诊断结果作为精子恢复的预测因素。所有患者均接受术前基因筛查。发现1例患者存在无精子因子c（AZFc）微缺失，5例被诊断为克氏综合征。
患者平均年龄为39.0（26 - 57）岁。27例男性通过m-TESE成功获取精子（46.5%）。FSH平均水平为19.4（1.6 - 58.5）IU/L。年龄（成功获取精子者平均年龄38.1岁，未获取者39.7岁，P = 0.38）、FSH水平（成功获取精子者平均FSH为21.4 IU/L，未获取者为17.7 IU/L，P = 0.3）与通过m-TESE找到精子的能力之间无相关性。然而，睾酮水平与精子获取情况存在显著差异（成功获取精子者平均睾酮水平为14.99 nmol/L，未获取者为11.39 nmol/L，P < 0.05）。诊断为唯支持细胞（SCO）综合征的患者[14/35（40%）]和生精阻滞患者[11例中的4例（36%）]的精子获取率低于精子发生低下组患者[12例中的9例（75.0%）]（P < 0.05）。m-TESE术后无明显并发症。
对于之前尝试取精结果为阴性的NOA男性，挽救性m-TESE即使在SCO综合征患者中也有很大机会找到精子。术前睾酮水平与成功找到精子的能力之间似乎存在相关性。
