显微切割睾丸取精术：非梗阻性无精子症患者的总体结果及术前睾酮水平对精子获取率的影响
Microdissection testicular sperm extraction: Overall results and impact of preoperative testosterone level on sperm retrieval rate in patients with nonobstructive azoospermia.
作者信息
Mehmood Shahbaz, Aldaweesh Shima, Junejo Noor Nabi, Altaweel Waleed Mohamed, Kattan Said Abdulghani, Alhathal Naif
机构信息
King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
出版信息
Urol Ann. 2019 Jul-Sep;11(3):287-293. doi: 10.4103/UA.UA_36_18.
OBJECTIVE
The main objective is to review the overall result and impact of preoperative testosterone level on sperm retrieval rate (SRR) by microdissection testicular sperm extraction (micro-TESE) in patients with nonobstructive azoospermia (NOA).
MATERIALS AND METHODS
We retrospectively reviewed the files of patients who underwent micro-TESE for NOA from August 2013 to December 2014. All patients were evaluated with history, physical examination, and hormonal assessment. Patients who had previous micro-TESE, obstructive azoospermia, or who took hormone therapy were excluded from the study. Patients were classified into two groups. Group A included patients who had low testosterone (<10 nmol/L), and Group B included patients with normal testosterone (>10 nmol/L). The primary endpoint was to review the overall results of the procedure and the impact of preoperative testosterone level on sperm retrieval.
RESULTS
A total of 264 patients with NOA underwent micro-TESE. Group A included 133 patients with low testosterone (<10 nmol/l) with a median age of 36 ± 6.59 years, and Group B included 131 patients with normal testosterone (>10 nmol/L) with a median age of 33 ± 7.88 years ( = 0.1350). There was no significant difference in follicle-stimulating hormone ( = 0.2467), luteinizing hormone ( = 0.1078), prolactin ( = 0.5619), and testicular volume ( = 0.4052), whereas a significant difference was found in testosterone level ( = 0.0001) in both groups. Overall, sperm were successfully retrieved in 48.8% of men. SRR in Group B was significantly higher (57.25%) than that in Group A (40.60%) ( = 0.0068). SRR in patients with Sertoli-cell-only pathology was 30.35%, hypospermatogenesis was 89.74%, and maturation arrest was 32.43%.
CONCLUSION
Micro-TESE is a successful and safe procedure in NOA patients with a poor prognosis. Preoperative testosterone level has a significant impact in the SRR by micro-TESE.
目的
主要目的是回顾术前睾酮水平对非梗阻性无精子症（NOA）患者经显微外科睾丸精子提取术（micro-TESE）的精子获取率（SRR）的总体结果和影响。
材料与方法
我们回顾性分析了2013年8月至2014年12月因NOA接受micro-TESE的患者资料。所有患者均进行了病史、体格检查和激素评估。曾接受过micro-TESE、梗阻性无精子症或接受过激素治疗的患者被排除在研究之外。患者分为两组。A组包括睾酮水平低（<10 nmol/L）的患者，B组包括睾酮水平正常（>10 nmol/L）的患者。主要终点是回顾手术的总体结果以及术前睾酮水平对精子获取的影响。
结果
共有264例NOA患者接受了micro-TESE。A组包括133例睾酮水平低（<10 nmol/l）的患者，中位年龄为36±6.59岁，B组包括131例睾酮水平正常（>10 nmol/L）的患者，中位年龄为33±7.88岁（P = 0.1350）。两组患者的促卵泡生成素（P = 0.2467）、促黄体生成素（P = 0.1078）、催乳素（P = 0.5619）和睾丸体积（P = 0.4052）无显著差异，而睾酮水平有显著差异（P = 0.0001）。总体而言，48.8%的男性成功获取了精子。B组的SRR显著高于A组（57.25%对40.60%）（P = 0.0068）。唯支持细胞病理患者的SRR为30.35%，生精功能低下患者为89.74%，成熟障碍患者为32.43%。
结论
对于预后不良的NOA患者，micro-TESE是一种成功且安全的手术。术前睾酮水平对micro-TESE的SRR有显著影响。
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