Institute of Andrology, University College London Hospital, London, UK.
Division of Surgery and Interventional Science, University College London, London, UK.
Andrology. 2020 Jan;8(1):166-170. doi: 10.1111/andr.12679. Epub 2019 Jul 10.
Adult undescended testicles (UDTs) often present to fertility specialists with subfertility or azoospermia and with either an intra-abdominal or inguinal testicle(s). Performing an orchidopexy followed by a surgical sperm retrieval (SSR) is a potential option to retrieve spermatozoa. A microdissection TESE (mTESE) procedure is performed to retrieve mature spermatozoa for use in ICSI. This paper reviews the outcomes of mTESE in adults following an orchidopexy.
A cohort of azoospermic patients underwent adult orchidopexy over a 10-year period at a single specialist centre. Data were collected retrospectively from the patient records retrieved from an institutional database. All patients underwent pre-operative imaging to localize the testicles, serum testosterone levels and a semen analysis. Separate intraoperative testicular biopsies were performed to exclude intratubular germ cell neoplasia (ITGCN) and to analyse the Johnsen score.
Twelve patients (age range 18-36 years) underwent orchidopexy procedures for either intra-abdominal or inguinal testicles. Mean follow-up was 34 months (range 13-58). Ninety per cent of patients had bilateral UDT with azoospermia. Pre-operative testosterone levels were within the normal range (mean 13.9 nmol/L; range 9.1-24.2). Five pelvic testicles (from four patients) were brought down and underwent a delayed mTESE. A total of nine inguinal orchidopexy procedures were carried out in eight men, and spermatozoa were found and preserved in three patients. None of the men with intra-abdominal testicles had mature spermatozoa present following a delayed mTESE. Overall, SSR was successful in 37.5% of the patients. Histological analysis showed no cases of ITGCN and the Johnsen scores ranged from 1 to 3.3.
Microdissection TESE following orchidopexy for inguinal testicles can result in a successful SSR in over 1/3rd of patients. Intra-abdominal testicles appear to lack spermatogonia although the testicles can still be preserved for endogenous hormone production. Adult orchidopexy allows preservation of endogenous testosterone, easier self-examination and an immediate or delayed mTESE in azoospermic patients.
成人未降睾丸（UDT）常因生育能力或无精子症而向生育专家就诊，且伴有腹腔内或腹股沟睾丸。进行睾丸固定术（orchidopexy）后进行外科取精术（SSR）是获取精子的潜在选择。进行微切割睾丸活检（mTESE）以获取成熟精子，用于 ICSI。本文回顾了在单一专业中心进行的 10 年间，对接受睾丸固定术的成年人进行 mTESE 的结果。
一组无精子症患者在 10 年内在单一专科中心接受了成人睾丸固定术。从机构数据库中检索患者记录，进行回顾性数据收集。所有患者均进行术前影像学检查以定位睾丸、血清睾酮水平和精液分析。同时进行术中睾丸活检，以排除管内生殖细胞肿瘤（ITGCN）并分析约翰森评分。
12 名患者（年龄 18-36 岁）因腹腔内或腹股沟睾丸接受睾丸固定术。平均随访时间为 34 个月（范围 13-58 个月）。90%的患者有双侧 UDT 伴无精子症。术前睾酮水平在正常范围内（平均 13.9nmol/L；范围 9.1-24.2）。5 个盆腔睾丸（来自 4 名患者）被降至下方，并进行了延迟 mTESE。8 名男性中进行了 9 例腹股沟睾丸固定术，3 名患者中发现并保存了精子。在接受延迟 mTESE 的腹腔内睾丸的男性中，均未发现成熟精子。总体而言，37.5%的患者 SSR 成功。组织学分析未见 ITGCN 病例，约翰森评分范围为 1-3.3。
腹股沟睾丸固定术后进行微切割睾丸活检可使超过 1/3 的患者 SSR 成功。尽管睾丸仍可保留用于内源性激素产生，但腹腔内睾丸似乎缺乏精原细胞。成人睾丸固定术可保留内源性睾酮，便于自我检查，并可立即或延迟进行 mTESE 治疗无精子症患者。
