Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada.
Department of Urology, College of Medicine, Qassim University, Qassim, Saudi Arabia.
Andrology. 2020 Sep;8(5):1136-1142. doi: 10.1111/andr.12795. Epub 2020 Apr 22.
Microdissection testicular sperm extraction (micro-TESE) is a procedure commonly utilized to harvest spermatozoa in severe male factor infertility. We have developed a technique involving a mini tunica albuginea incision with superficial tissue dissection (mini-incision micro-TESE). The modification is designed to reduce potential tissue injury, and we studied its effectiveness to harvest spermatozoa in men with cryptozoospermia and non-obstructive azoospermia.
We performed a retrospective analysis of 103 infertile men with NOA and cryptozoospermia who underwent a mini-incision micro-TESE between March 2015 and August 2018 at the OVO fertility clinic. We consider the mini-incision micro-TESE procedure successful when at least five spermatozoa are identified in the micro-biopsies obtained from the superficial tissue exposed by the 1-cm mini-incision. If no spermatozoa are identified through the mini-incision, we can easily extend the incision to the standard micro-TESE.
The mini-incision procedure allowed for successful recovery of spermatozoa (intra-operative recovery of ≥ 5 spermatozoa) in 58% of men with cryptozoospermia and 25.6% of men with NOA. Overall, a successful sperm retrieval (with conversion to conventional micro-TESE if mini-incision was not successful) was achieved in 89% of men with cryptozoospermia and 48% of men with NOA. A successful mini-incision micro-TESE was associated with a significantly lower number of biopsies than conventional micro-TESE (8.8 vs 24.2, P < .0001). Moreover, in men undergoing a redo micro-TESE after a previously successful micro-TESE, 64% (9/14) had spermatozoa found and 21% (3/14) of these men only required a mini-incision micro-TESE.
Our data suggest that mini-incision micro-TESE is a useful approach in men undergoing micro-TESE, allowing for a shorter incision and a high sperm retrieval rate in men with cryptozoospermia. Furthermore, the findings of our study offer insight into the distribution of spermatogenesis in men with cryptozoospermia and NOA.
微量睾丸精子提取（micro-TESE）是一种常用于严重男性因素不育症中获取精子的程序。我们开发了一种涉及微小白膜切口和浅表组织解剖（微型切口 micro-TESE）的技术。这种改良旨在减少潜在的组织损伤，我们研究了其在隐匿性精子症和非阻塞性无精子症男性中获取精子的有效性。
我们对 2015 年 3 月至 2018 年 8 月在 OVO 生育诊所接受微型切口 micro-TESE 的 103 名非梗阻性无精子症和隐匿性精子症的不育男性进行了回顾性分析。当从 1 厘米微型切口暴露的浅表组织中获得的微活检中至少鉴定出 5 个精子时，我们认为微型切口 micro-TESE 程序是成功的。如果无法通过微型切口识别精子，我们可以轻松地将切口扩展到标准 micro-TESE。
微型切口程序使 58%的隐匿性精子症男性和 25.6%的非梗阻性无精子症男性成功恢复了精子（术中恢复≥5 个精子）。总体而言，隐匿性精子症男性中有 89%和非梗阻性无精子症男性中有 48%成功获得了精子提取（如果微型切口不成功，则转换为常规 micro-TESE）。与传统 micro-TESE 相比，成功的微型切口 micro-TESE 活检次数明显减少（8.8 次与 24.2 次，P<0.0001）。此外，在先前成功进行 micro-TESE 后再次进行 micro-TESE 的男性中，有 64%（9/14）发现了精子，其中 21%（3/14）仅需要微型切口 micro-TESE。
我们的数据表明，微型切口 micro-TESE 是进行 micro-TESE 的男性的一种有用方法，可通过较短的切口获得较高的精子回收率，并适用于隐匿性精子症男性。此外，我们的研究结果提供了对隐匿性精子症和非梗阻性无精子症男性生精分布的深入了解。
