睾丸精子抽吸术（TESA）或微切割睾丸精子提取术（Micro-tese）：在患有隐匿性少精子症和严重少精子症的男性中，哪种方法更好？

Testicular Sperm Aspiration (TESA) or Microdissection Testicular Sperm Extraction (Micro-tese): Which Approach is better in Men with Cryptozoospermia and Severe Oligozoospermia?

机构信息

Division of Urology, Department of Surgery, McGill University, Montreal, Canada.

Faculty of Medicine, McGill University, Montreal, Canada.

出版信息

Urology. 2021 Aug;154:164-169. doi: 10.1016/j.urology.2021.04.037. Epub 2021 May 13.

DOI:10.1016/j.urology.2021.04.037

PMID:33991573

Abstract

OBJECTIVES

To evaluate and compare sperm retrieval outcomes by testicular sperm aspiration (TESA) and micro-dissection testicular sperm extraction (micro-TESE) in non-azoospermic men.

METHODS

We conducted a retrospective study of 145 consecutive testicular sperm retrievals in men with cryptozoospermia (n = 56) or severe oligozoospermia (n = 84). The decision to perform a TESA or a micro-TESE was made after thorough discussion of the pros and cons of these procedures with the couple. Final assessment of sperm recovery, on the day of ICSI, was reported either as successful (available sperm for ICSI) or unsuccessful (no sperm for ICSI).

RESULTS

Mean sperm concentration, sperm motility, testicular volume and serum FSH level of men undergoing TESA were not significantly different from those of men undergoing micro-TESE. In men with severe oligozoospermia (<5 million/ml), sperm recovery was successful in 95% (18/19) of those who underwent micro-TESE and in 92% (60/65) of those who underwent TESA (P > 0.05). In men with cryptozoospermia, sperm recovery was successful in 88% (42/48) of men who underwent micro-TESE and 25% (2/8) of men who underwent TESA (P < .001).

CONCLUSIONS

These data indicate that in men with severe oligozoospermia, TESA and micro-TESE are equally successful sperm retrieval techniques. However, in men with cryptozoospermia, sperm retrieval rates are significantly higher with micro-TESE than TESA.

摘要

目的

评估和比较非严重少精子症（隐匿性精子症）或严重少精子症（严重少精症）男性经睾丸精子抽吸术（TESA）和显微镜下睾丸精子提取术（micro-TESE）获取精子的结果。

方法

我们对 145 例隐匿性精子症（n=56）或严重少精症（n=84）男性进行了回顾性研究。这些患者均接受了睾丸精子提取术，我们在与夫妇充分讨论这些手术的优缺点后，决定进行 TESA 还是 micro-TESE。在 ICSI 当天，根据精子回收情况报告最终评估结果，结果分为成功（有用于 ICSI 的精子）和不成功（无用于 ICSI 的精子）。

结果

接受 TESA 的男性的精子浓度、精子活力、睾丸体积和血清 FSH 水平与接受 micro-TESE 的男性无显著差异。在严重少精症（<500 万/ml）男性中，micro-TESE 组有 95%（18/19）的患者精子回收成功，TESA 组有 92%（60/65）的患者精子回收成功（P>0.05）。在隐匿性精子症男性中，micro-TESE 组有 88%（42/48）的患者精子回收成功，而 TESA 组只有 25%（2/8）的患者精子回收成功（P<0.001）。