Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Department of Urology, Weill Cornell Medicine, New York, New York.
Fertil Steril. 2019 Sep;112(3):426-437. doi: 10.1016/j.fertnstert.2019.06.022.
Over the past few decades, there have been numerous paradigm shifts in male reproductive surgery, resulting from a combination of technologic advancements in both the operating room and the laboratory. The operating microscope transformed the field of male reproductive surgery, enabling novel techniques and higher precision for the treatment of male-factor subfertility. The subsequent widespread adoption of microsurgical approaches was largely responsible for the emergence of a cadre of highly specialized male infertility microsurgeons. The advent and evolution of in vitro fertilization/intracytoplasmic sperm injection was a concurrent story that further revolutionized the field. The ability to achieve fertilization and pregnancy with just a single sperm changed the ways in which male reproductive surgeons could approach a wide range of pathologies from obstructive to nonobstructive causes, culminating in the microdissection testicular sperm extraction procedure for the treatment of nonobstructive azoospermia. Here we review the recent advancements in fertility-enhancing male reproductive surgery for the treatment of four disease processes: varicocele, obstruction of the excurrent ductal system, ejaculatory duct obstruction, and nonobstructive azoospermia. While examining the great strides of the past, we look forward to exciting developments on the horizon.
在过去的几十年中，由于手术室和实验室技术的进步，男性生殖外科领域发生了许多范式转变。手术显微镜改变了男性生殖外科领域，为男性因素不育症的治疗提供了新的技术和更高的精度。随后，显微手术方法的广泛采用在很大程度上促成了一批高度专业化的男性不育症显微外科医生的出现。体外受精/胞浆内精子注射的出现和发展是一个并行的故事，进一步彻底改变了这一领域。仅用单个精子就能实现受精和妊娠的能力改变了男性生殖外科医生处理从梗阻性到非梗阻性病因的广泛病理的方式，最终导致了用于治疗非梗阻性无精子症的睾丸精子提取微分离手术。在这里，我们回顾了最近在治疗四种疾病过程中的生育增强型男性生殖外科的进展：精索静脉曲张、外分泌导管系统梗阻、射精管梗阻和非梗阻性无精子症。在审视过去的巨大进步的同时，我们也期待着未来令人兴奋的发展。
