在显微镜下睾丸精子提取术时高倍放大评估曲细精管直径模式可预测非梗阻性无精子症患者的精子获取情况。

The seminiferous tubule caliber pattern as evaluated at high magnification during microdissection testicular sperm extraction predicts sperm retrieval in patients with non-obstructive azoospermia.

机构信息

Department of Maternal and Child Health, Reproductive and IVF Unit, Asl Bari, Conversano, Italy.

Andrology and IVF Unit, Clinica San Carlo, Paderno Dugnano, Italy.

出版信息

Andrology. 2019 Jan;7(1):8-14. doi: 10.1111/andr.12548. Epub 2018 Sep 26.

DOI:10.1111/andr.12548

PMID:30259683

Abstract

BACKGROUND

microTESE proved to be the gold standard surgical approach for patients with non-obstructive azoospermia (NOA), but sperm retrieval rates (SRRs) vary considerably among centers. Some authors compared their SRRs with the pattern of seminiferous tubule caliber found at high magnification, but none provided diagnostic accuracy measures.

OBJECTIVE

The present retrospective study sought to verify the diagnostic accuracy of the pattern of seminiferous tubule caliber in predicting the sperm retrieval in NOA patients.

MATERIALS AND METHODS

Data from 143 infertile NOA men undergoing unilateral (64) or bilateral (79) microTESE (222 testes) were retrospectively evaluated. During microTESE, if present, dilated tubules (DTs) were retrieved, otherwise tubules with slightly larger caliber (SDT) (×24) than that of the surroundings were removed. When no DT or SDT were found, not dilated tubules (NDTs) were excised.

RESULTS

Spermatozoa were retrieved in 95 of 222 testes (42.8%); sperm retrieval was successful in 90% of testes with DTs, in 47% of those with SDTs, and only in 7% of those with NDTs (p < 0.0001). Stepwise binary logistic regression revealed that the combination of seminiferous tubule pattern and testis histology was significantly predictive of SSR, being able to classify 86.8% of testes, with an excellent diagnostic accuracy (AUC 0.93). The median number of spermatozoa retrieved was significantly higher in DTs compared with SDTs and NDTs.

DISCUSSION

The results of the present study provide reliable accuracy measures in support of the relationship between seminiferous tubule caliber pattern and SSR in patients with non-obstructive azoospermia. We are proposing for the first time that spermatozoa may be retrieved even from slightly dilated tubules in about half of cases. The pattern of tubules retrieved, together with histology, may represent an additional outcome measure of microTESE.

CONCLUSION

The pattern of seminiferous tubules together with testis histology predicts sperm retrieval with an excellent diagnostic accuracy.

摘要

背景

显微睾丸切开取精术（microTESE）已被证明是治疗非梗阻性无精子症（NOA）患者的金标准手术方法，但各中心的精子获取率（SRR）差异很大。一些作者将他们的 SRR 与高倍镜下发现的生精小管口径模式进行了比较，但没有提供诊断准确性的衡量标准。

目的

本回顾性研究旨在验证生精小管口径模式预测 NOA 患者精子获取的诊断准确性。

材料与方法

回顾性分析了 143 例接受单侧（64 例）或双侧（79 例） microTESE（222 个睾丸）的不育性 NOA 男性的数据。在 microTESE 过程中，如果存在扩张的小管（DT），则将其取出，否则将取出比周围稍大口径（SDT）（×24）的小管。当没有 DT 或 SDT 时，切除非扩张的小管（NDT）。

结果

222 个睾丸中有 95 个（42.8%）获得了精子;DT 组精子获取成功率为 90%，SDT 组为 47%，NDT 组仅为 7%（p<0.0001）。逐步二元逻辑回归显示，生精小管模式和睾丸组织学的组合对 SSR 具有显著的预测作用，能够对 86.8%的睾丸进行分类，具有极好的诊断准确性（AUC 0.93）。与 SDT 和 NDT 相比，DT 中获得的精子数量明显更高。