Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada.
Faculty of Medicine, McGill University, Montreal, QC, Canada.
Andrologia. 2021 Dec;53(11):e14208. doi: 10.1111/and.14208. Epub 2021 Aug 5.
Men with nonobstructive azoospermia (NOA), cryptozoospermia and severe oligozoospermia are candidates for microdissection testicular sperm extraction (micro-TESE) and intracytoplasmic sperm injection (ICSI). We sought to evaluate micro-TESE outcomes and the need for bilateral testicular exploration in the three groups of men.
We conducted a retrospective study of 233 consecutive micro-TESEs in men with nonobstructive azoospermia (n = 173), cryptozoospermia (n = 43) and severe oligozoospermia (n = 17). The decision to terminate the micro-TESE after a unilateral or bilateral testicular exploration was determined at the time of surgery and was based on the presence or absence of mature spermatozoa in the harvested micro-biopsies. Final assessment of sperm recovery, on the day of ICSI, was reported as successful (available spermatozoon for ICSI) or unsuccessful (no spermatozoon for ICSI).
Unilateral testicular exploration resulted in successful sperm retrieval in 43% (75/173), 79% (34/43) and 100% (17/17) of men with NOA, cryptozoospermia and severe oligozoospermia respectively. Therefore, 57%, 21% and none of the men with NOA, cryptozoospermia and severe oligozoospermia, respectively, required a bilateral micro-TESE. Overall, micro-TESE resulted in successful sperm retrieval in 52% (90/173), 91% (39/43) and 100% (17/17) of men with NOA, cryptozoospermia and severe oligozoospermia respectively.
Our data indicate that men with severe oligozoospermia are unlikely to require a bilateral testicular exploration at micro-TESE. Moreover, most cryptozoospermic men will have a successful sperm retrieval by micro-TESE with the majority of these patients requiring a unilateral exploration. In contrast, over 50% of the men with nonobstructive azoospermia will require a bilateral micro-TESE.
非梗阻性无精子症（NOA）、隐匿性精子症和严重少精子症患者适合进行睾丸精子抽吸术（micro-TESE）和胞浆内单精子注射（ICSI）。我们旨在评估这三组患者的 micro-TESE 结果和双侧睾丸探查的必要性。
我们对 233 例非梗阻性无精子症（n=173）、隐匿性精子症（n=43）和严重少精子症（n=17）患者进行了回顾性研究。单侧或双侧睾丸探查后是否终止 micro-TESE 的决定是在手术时根据收获的微活检中是否存在成熟精子来确定的。ICSI 当天报告精子回收的最终评估结果为成功（有可用于 ICSI 的精子）或不成功（无可用于 ICSI 的精子）。
单侧睾丸探查分别使 43%（75/173）、79%（34/43）和 100%（17/17）的 NOA、隐匿性精子症和严重少精子症患者获得了成功的精子提取。因此，NOA、隐匿性精子症和严重少精子症患者分别有 57%、21%和 0 名患者需要进行双侧 micro-TESE。总的来说，micro-TESE 分别使 52%（90/173）、91%（39/43）和 100%（17/17）的 NOA、隐匿性精子症和严重少精子症患者获得了成功的精子提取。
我们的数据表明，严重少精子症患者在 micro-TESE 时不太可能需要双侧睾丸探查。此外，大多数隐匿性精子症患者通过 micro-TESE 可获得成功的精子提取，其中大多数患者需要单侧探查。相比之下，超过 50%的非梗阻性无精子症患者将需要双侧 micro-TESE。
