Maglia Elia, Boeri Luca, Fontana Matteo, Gallioli Andrea, De Lorenzis Elisa, Palmisano Franco, Zanetti Stefano, Sampogna Gianluca, Restelli Liliana, Somigliana Edgardo, Serrago Mariapia, Gadda Franco, Montanari Emanuele
IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Department of Urology, Milan.
Arch Ital Urol Androl. 2018 Jun 30;90(2):130-135. doi: 10.4081/aiua.2018.2.130.
The superiority of microdissection testicular sperm extraction (mTESE) over conventional TESE (cTESE) for men with non-obstructive azoospermia (NOA) is debated. We aimed to compare the sperm retrieval rate (SRR) of mTESE to cTESE and to identify candidates who would most benefit from mTESE in a cohort of Caucasian-European men with primary couple's infertility.
Data from 49 mTESE and 96 cTESE patients were analysed. We collected demographic and clinical data, serum levels of LH, FSH and total testosterone. Patients with abnormal karyotyping were excluded from analysis. Age was categorized according to the median value of 35 years. FSH values were dichotomized according to multiples of the normal range (N) (N and 1.5 N: 1-18 mIU/mL, and > 18 mIU/mL). Testicular histology was recorded for each patient. Descriptive statistics and logistic regression analyses tested the impact of potential predictors on positive SRR in both groups.
No differences were found between groups in terms of clinical and hormonal parameters with the exception of FSH values that were higher in mTESE patients (p = 0.004). SRR were comparable between mTESE and cTESE (49.0% vs. 41.7%, p = 0.40). SRRs were significantly higher after mTESE in patients with Sertoli cell-only syndrome (SCOS) (p = 0.038), in those older than 35 years (p = 0.03) and with FSH >1.5N (p < 0.001), as compared to men submitted to cTESE. Multivariable logistic regression analysis showed that mTESE was independent predictor of positive SR in patients older than 35 years (p = 0.002) and with FSH > 1.5N (p = 0.018). Moreover, increased FSH levels (p = 0.03) and both SCOS (p = 0.01) and MA histology (p = 0.04) were independent predictors of SRR failure.
Microdissection and cTESE showed comparable success rates in our cohort of patients with NOA. mTESE seems beneficial for patients older than 35 years, with high FSH values, or when SCOS can be predicted. Given the high costs associated with the mTESE approach, the identification of candidates most likely to benefit from this procedure is a major clinical need.
对于非梗阻性无精子症（NOA）男性患者，睾丸显微取精术（mTESE）相对于传统睾丸切开取精术（cTESE）的优势存在争议。我们旨在比较mTESE与cTESE的精子获取率（SRR），并在一组患有原发性夫妻不育症的白种欧洲男性队列中，确定最能从mTESE中获益的候选者。
分析了49例接受mTESE和96例接受cTESE患者的数据。我们收集了人口统计学和临床数据、血清促黄体生成素（LH）、促卵泡生成素（FSH）和总睾酮水平。染色体核型异常的患者被排除在分析之外。年龄根据35岁的中位数进行分类。FSH值根据正常范围（N）的倍数进行二分法划分（N和1.5N：1 - 18 mIU/mL，以及> 18 mIU/mL）。记录每位患者的睾丸组织学情况。描述性统计和逻辑回归分析测试了潜在预测因素对两组中SRR阳性的影响。
两组在临床和激素参数方面未发现差异，但mTESE患者的FSH值较高（p = 0.004）。mTESE和cTESE的SRR相当（49.0%对41.7%，p = 0.40）。与接受cTESE的男性相比，患有唯支持细胞综合征（SCOS）的患者（p = 0.038）、年龄大于35岁的患者（p = 0.03）以及FSH > 1.5N的患者（p < 0.001），mTESE后的SRR显著更高。多变量逻辑回归分析表明，mTESE对于年龄大于35岁（p = 0.002）和FSH > 1.5N（p = 0.018）的患者是SR阳性的独立预测因素。此外，FSH水平升高（p = 0.03）以及SCOS（p = 0.01）和成熟型精原细胞瘤（MA）组织学（p = 0.04）是SRR失败的独立预测因素。
在我们的NOA患者队列中，显微取精术和cTESE显示出相当的成功率。mTESE似乎对年龄大于35岁、FSH值高或可预测为SCOS的患者有益。鉴于mTESE方法相关的高成本，识别最有可能从该手术中获益的候选者是一项重大的临床需求。
