Academic Urology Unit, University of Sheffield, Sheffield, UK.
Section of Andrology, Pyrah Department of Urology, St James's Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Int J Impot Res. 2022 Sep;34(6):543-551. doi: 10.1038/s41443-021-00492-x. Epub 2021 Nov 6.
Subfertility is a risk factor for testicular cancers (TT), and conversely, TT may induce subfertility due to local and regional toxic effects. We aimed to identify the association between TT characteristics and pre-orchidectomy azoospermia. A systematic review of the literature was performed according to the PRISMA checklist. Overall, eight non-randomised studies involving 469 men with TT (azoospermia, n = 57; no azoospermia n = 412) were included in the qualitative analysis. Bilateral TT (12.3% vs 2.9% in non-azoospermia), non-seminoma germ cell tumours (6.4% vs 1.9%), germ cell neoplasia in-situ (GCNIS) (11.1% vs 1.2%), stage 2-3 disease (22.2% vs 0%), Sertoli Cell only (SCO) on biopsy (60% vs 37.5%) and a history of undescended testis (UDT) (66.7% vs 50%) were more common in azoospermic men. FSH levels are higher (18.7-23.2 mIU/L vs <0.1-8 mIU/L in non-azoospermia), testosterone is lower, and testis size are smaller (lower range 1 mL vs 10 mL) in men with azoospermia. Leydig cell tumours and hyperplasia were only detected in men with azoospermia. In summary, bilateral TT, GCNIS, higher tumour stage, smaller testes, SCO and history of UDT may have direct effects on spermatogenesis. Small testis, raised FSH and low testosterone may reflect reduced testicular function in azoospermic men. Performing a pre-orchidectomy semen analysis is important to identify those with azoospermia or severe oligospermia in order to plan for cryopreservation or onco-TESE in young men who wish to conceive.
不育症是睾丸癌（TT）的一个风险因素，相反，由于局部和区域的毒性作用，TT 也可能导致不育。我们旨在确定 TT 特征与去势前无精子症之间的关联。根据 PRISMA 清单对文献进行了系统回顾。总体而言，纳入了 8 项非随机研究，涉及 469 名 TT 男性（无精子症，n=57；非无精子症，n=412）。纳入了定性分析。双侧 TT（无精子症中为 12.3%，非无精子症中为 2.9%）、非精原细胞瘤生殖细胞肿瘤（6.4%，非无精子症中为 1.9%）、原位生殖细胞瘤内变（GCNIS）（11.1%，非无精子症中为 1.2%）、2-3 期疾病（22.2%，非无精子症中为 0%）、活检时仅支持细胞（SCO）（60%，非无精子症中为 37.5%）和隐睾病史（66.7%，非无精子症中为 50%）在无精子症男性中更为常见。无精子症男性的 FSH 水平更高（18.7-23.2 mIU/L，非无精子症中<0.1-8 mIU/L），睾酮水平较低，睾丸体积较小（较低范围 1 mL，非无精子症中为 10 mL）。只有在无精子症男性中才检测到间质细胞瘤和增生。总之，双侧 TT、GCNIS、较高的肿瘤分期、较小的睾丸、SCO 和隐睾病史可能对精子发生有直接影响。小睾丸、FSH 升高和睾酮降低可能反映了无精子症男性睾丸功能下降。在去势前进行精液分析对于识别那些无精子症或严重少精子症的男性很重要，以便计划在那些希望生育的年轻男性中进行冷冻保存或肿瘤睾丸精子提取术。
