Bouker Amin, Halouani Lazhar, Kharouf Mahmoud, Latrous Habib, Makni Mounir, Marrakchi Ouafi, Zouari Raoudha, Fourati Salima
CPSR, department of AMP, Clinique Les Jasmins, Tunis, Tunisia.
Basic Clin Androl. 2019 Jul 15;29:11. doi: 10.1186/s12610-019-0091-9. eCollection 2019.
Men with non-obstructive azoospermia (NOA) may have sperm in their testes and a procedure of sperm retrieval and assisted reproduction is required in them to allow fertility. Standard procedures such as fine needle aspiration (FNA) and conventional testicular sperm extraction (cTESE) harvest random samples with a sperm retrieval rate (SRR) of 45%. Microdissection testicular sperm extraction (mTESE) is nowadays considered to be the most accurate technique to retrieve sperm in men with NOA. This procedure can identify dilated tubules that are more likely to contain viable sperm with a SRR of 60%.
In our center, testicular biopsy was conducted in a standard fashion in 321 patients with NOA until March 2003. From then to December 2017, due to the lack of an operating microscope, we used 6 fold magnifying loupes to perform a step-by-step macro- mTESE in 1050 patients. Sperm was found in the first testis in 61% of the cases, leading to stop the procedure with less testicular damage. We increased our SRR from 43 to 51.8% in an acceptable operating time of 75mn for both sides.
In institutions where surgeons cannot afford an operating microscope, this modified mTESE technique using × 6 magnifying loupes is reliable, especially in patients with low testicular volumes and high FSH, in whom dilated tubules can be easily identified from the surrounding tissue.
非梗阻性无精子症（NOA）男性的睾丸中可能存在精子，他们需要进行精子获取和辅助生殖程序才能实现生育。诸如细针抽吸（FNA）和传统睾丸精子提取（cTESE）等标准程序采集的是随机样本，精子获取率（SRR）为45%。如今，显微切割睾丸精子提取术（mTESE）被认为是在NOA男性中获取精子最准确的技术。该程序可以识别更有可能含有活精子的扩张小管，精子获取率为60%。
在我们中心，直到2003年3月，对321例NOA患者以标准方式进行了睾丸活检。从那时到2017年12月，由于缺乏手术显微镜，我们使用6倍放大的放大镜对1050例患者进行了逐步宏观mTESE。61%的病例在第一个睾丸中发现了精子，从而在对睾丸损伤较小的情况下停止了手术。在两侧75分钟的可接受手术时间内，我们将精子获取率从43%提高到了51.8%。
在外科医生无法负担手术显微镜的机构中，这种使用×6放大镜的改良mTESE技术是可靠的，尤其是在睾丸体积小和促卵泡激素（FSH）高的患者中，在这些患者中可以很容易地从周围组织中识别出扩张的小管。
