Department of Urology, Rabin Medical Center, Petah Tikva, Israel.
Department of Urology, Rabin Medical Center, Petah Tikva, Israel.
Fertil Steril. 2016 Jul;106(1):70-74. doi: 10.1016/j.fertnstert.2016.03.012. Epub 2016 Mar 19.
To assess the ability of semen analysis and other patients' characteristics to predict the presence of spermatozoa in radical orchiectomy pathological specimen, and describe potential implications for patients with azoospermia and testis cancer.
Retrospective cohort study.
Tertiary hospital.
PATIENT(S): A total of 214 consecutive patients with testicular cancer who underwent radical orchiectomy between 1997 and 2015.
INTERVENTION(S): None.
MAIN OUTCOME MEASURE(S): Histologic slides were reviewed and the presence of mature spermatozoa was documented. Clinical, laboratory, and radiographic characteristics were recorded. Logistic regression analyses were used to identify factors associated with the presence of spermatozoa in the noninvolved ipsilateral testicular parenchyma.
RESULT(S): Spermatozoa were found in the pathological specimen of 145 patients (67.8%). At multivariate analysis, increased tumor size was the only factor associated with lower rates of spermatozoa in the specimen. Mean tumor diameter was 4.06 cm, and spermatozoa were found in 83% and 49% of testes with tumor diameters <4 and ≥4 cm, respectively. Preoperative semen analysis records were available for 107 patients. Oligozoospermia, severe oligozoospermia, azoospermia, and cryptozoospermia were observed in 17 (16%), 18 (17%), 9 (8%) and 3 (3%) patients, respectively. Sperm concentration and motility were not associated with complete spermatogenesis. Seven of 12 patients (58%) with either azoospermia or cryptozoospermia had mature sperm in their pathological sections.
CONCLUSION(S): Larger testicular cancers are associated with lower rates of spermatozoa in the ipsilateral testis. Given the substantial likelihood (∼60%) of spermatozoa to be present in the cancerous testis of patients with azoospermia and cryptozoospermia, concomitant oncologic testicular sperm extraction (TESE) can be considered in these selected patients.
评估精液分析和其他患者特征预测根治性睾丸切除术病理标本中精子存在的能力，并描述其对非梗阻性无精子症和睾丸癌患者的潜在影响。
回顾性队列研究。
三级医院。
1997 年至 2015 年间共 214 例接受根治性睾丸切除术的睾丸癌患者。
无。
对组织切片进行复查，并记录成熟精子的存在情况。记录临床、实验室和影像学特征。采用逻辑回归分析来确定与非受累对侧睾丸实质中精子存在相关的因素。
145 例患者（67.8%）的病理标本中发现精子。多变量分析显示，肿瘤体积增大是与标本中精子率降低相关的唯一因素。肿瘤平均直径为 4.06cm，肿瘤直径<4cm 和≥4cm 的睾丸中分别有 83%和 49%的睾丸发现精子。107 例患者有术前精液分析记录。观察到少精子症、严重少精子症、无精子症和隐匿精子症分别为 17 例（16%）、18 例（17%）、9 例（8%）和 3 例（3%）。精子浓度和活力与完全精子发生无关。12 例无精子症或隐匿精子症患者中，有 7 例（58%）在病理切片中发现成熟精子。
较大的睾丸肿瘤与同侧睾丸精子率降低相关。鉴于无精子症和隐匿精子症患者癌症睾丸中精子存在的可能性较大（约 60%），在这些选定的患者中可考虑同时进行肿瘤睾丸精子提取（TESE）。
