Department of Urology, Weill Cornell Medical College, New York, New York.
Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York.
J Urol. 2021 Nov;206(5):1268-1275. doi: 10.1097/JU.0000000000001951. Epub 2021 Jun 29.
We sought to determine if testicular histopathological heterogeneity is associated with sperm retrieval rates (SRRs) in men with nonobstructive azoospermia (NOA) who are undergoing microdissection testicular sperm extraction (mTESE).
All patients undergoing mTESE by a single, high-volume surgeon at a tertiary infertility referral center between 2010 and 2020 were evaluated. Pathology reports from testis biopsy at the time of mTESE reported by fellowship-trained genitourinary pathologists were reviewed. Testicular heterogeneity was correlated to absolute SRRs. Logistic regression was used to determine if heterogeneity was associated with sperm retrieval.
A total of 918 men with mTESE were included. Of these, 391 men (43%) had 1 pathology, 388 men (42%) had 2, 108 (12%) had 3, and 31 (3.4%) had 4. Overall, the most common histopathology was Sertoli-cell only, followed by maturation arrest. The overall SRR was 42% with a clinical intrauterine gestation rate of 30%. Increasing histopathological variety was associated with higher SRRs (p <0.01); a SRR of 33% was observed when one histopathological subtype was present vs 94% with 4 subtypes. Furthermore, men with any foci of spermatogenesis had higher SRRs.
In men with NOA, increasing testicular histopathological heterogeneity is correlated with higher SRRs driven by the identification of focal areas of spermatogenesis. This is an important, although predictable, observation. While diagnostic biopsy is not routinely required, these findings emphasize the value of having histology to perhaps predict the chance of sperm retrieval for future mTESE procedures.
我们旨在确定在接受显微睾丸精子提取术（mTESE）的非梗阻性无精子症（NOA）男性中，睾丸组织病理学异质性是否与精子获取率（SRR）相关。
评估了 2010 年至 2020 年间在一家三级不孕转诊中心由一位经验丰富的高容量外科医生进行 mTESE 的所有患者。回顾了由接受过泌尿生殖系统病理学培训的病理学家在 mTESE 时报告的睾丸活检的病理报告。将睾丸异质性与绝对 SRR 相关联。使用逻辑回归来确定异质性是否与精子获取相关。
共纳入 918 例接受 mTESE 的男性。其中，391 例（43％）患者的病理报告为 1 种，388 例（42％）患者为 2 种，108 例（12％）患者为 3 种，31 例（3.4％）患者为 4 种。总体而言，最常见的组织病理学表现为唯支持细胞，其次是成熟阻滞。总体 SRR 为 42％，临床宫内妊娠率为 30％。组织病理学种类的增加与更高的 SRR 相关（p<0.01）；当存在 1 种组织病理学亚型时，SRR 为 33％，而存在 4 种亚型时，SRR 为 94％。此外，存在任何生精灶的男性具有更高的 SRR。
在 NOA 男性中，睾丸组织病理学异质性的增加与更高的 SRR 相关，这是由生精灶的鉴定驱动的。这是一个重要的观察结果，尽管可以预测。虽然通常不需要进行诊断性活检，但这些发现强调了组织学的价值，可能有助于预测未来 mTESE 手术中精子获取的机会。
