Alrabeeah K, Witmer J, Ruiz S, AlMalki A, Phillips S, Zini A
McGill University, Montreal, QC, Canada.
Ovo Fertility Clinic, Montreal, QC, Canada.
Andrology. 2016 Mar;4(2):284-9. doi: 10.1111/andr.12152. Epub 2016 Jan 6.
Microdissection testicular sperm extraction (micro-TESE) was developed to minimize the testicular injury associated with multiple open TESEs. We sought to evaluate a mini-incision micro-TESE in men with cryptozoospermia and non-obstructive azoospermia (NOA). We conducted a retrospective study of 26 consecutive men with NOA and cryptozoospermia who underwent a primary (first) micro-TESE between March 2015 and August 2015. Final assessment of sperm recovery (reported on the day of intra-cytoplasmic sperm injection (ICSI)) was recorded as (i) successful (available spermatozoa for ICSI) or (ii) unsuccessful (no spermatozoa for ICSI). The decision to perform a mini-incision micro-TESE (with limited unilateral micro-dissection) or standard/extensive (with unilateral or bilateral micro-dissection) was guided by the intra-operative identification of sperm recovery (≥5 spermatozoa) from the first testicle. Overall, sperm recovery was successful in 77% (20/26) of the men. In 37% of the men (8/26), the mini-incision micro-TESE was successful (positive sperm recovery). The remaining 18 men required a standard (extensive) microdissection: 61% (11/18) underwent a unilateral and 39% (7/18) a bilateral micro-TESE. We found that 90% (9/10) of the men with cryptozoospermia and 63% (10/16) of the men with NOA underwent a unilateral (mini or standard micro-TESE). The mini-incision micro-TESE allowed for successful sperm recovery in 60% (6/10) of the men with cryptozoospermia and 13% (2/16) of the men with NOA. The data demonstrate that a mini-incision micro-TESE together with rapid intra-operative assessment and identification of spermatozoa recovery can be useful in men undergoing microTESE, particularly, men with cryptozoospermia.
显微切割睾丸取精术（micro-TESE）的开发是为了将与多次开放性睾丸取精术相关的睾丸损伤降至最低。我们试图评估一种小切口显微切割睾丸取精术在隐匿性无精子症和非梗阻性无精子症（NOA）男性中的应用。我们对2015年3月至2015年8月期间连续26例接受初次（首次）显微切割睾丸取精术的NOA和隐匿性无精子症男性进行了一项回顾性研究。精子回收的最终评估（在卵胞浆内单精子注射（ICSI）当天报告）记录为：（i）成功（有可供ICSI的精子）或（ii）失败（无可供ICSI的精子）。进行小切口显微切割睾丸取精术（有限的单侧显微切割）或标准/广泛（单侧或双侧显微切割）的决定是根据术中从第一个睾丸中回收精子（≥5个精子）的情况来指导的。总体而言，77%（20/26）的男性精子回收成功。在37%的男性（8/26）中，小切口显微切割睾丸取精术成功（精子回收阳性）。其余18名男性需要进行标准（广泛）显微切割：61%（11/18）接受单侧显微切割，39%（7/18）接受双侧显微切割。我们发现，90%（9/10）的隐匿性无精子症男性和63%（10/16）的NOA男性接受了单侧（小切口或标准显微切割睾丸取精术）。小切口显微切割睾丸取精术使60%（6/10）的隐匿性无精子症男性和13%（2/16） 的NOA男性成功回收精子。数据表明，小切口显微切割睾丸取精术以及术中快速评估和精子回收鉴定对接受显微切割睾丸取精术的男性，特别是隐匿性无精子症男性可能有用。
