Tai Meng-Che, Huang I-Shen, Huang Chen-Yu, Huang William J
Division of Urology, Department of Surgery, Taipei Veterans General Hospital Taoyuan Branch, Taipei, Taiwan, ROC.
Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2023 Mar 1;86(3):300-305. doi: 10.1097/JCMA.0000000000000842. Epub 2022 Nov 8.
Microdissection testicular sperm extraction (mTESE) is the mainstay of sperm retrieval in men with nonobstructive azoospermia (NOA). Some experts believe that a resting period of ≥6 months is required between procedures to ensure better sperm retrieval rates and fewer complications. However, no scientific studies have investigated how long patients should wait before arranging a second mTESE procedure. This retrospective study aimed to evaluate whether good success rates are still achieved when a repeat mTESE procedure is performed within 6 months.
Total 146 patients with NOA who underwent mTESE twice from the same testis between May 2012 and September 2019 were retrospectively collected. These patients were categorized into three groups according to the time interval between the two mTESE surgeries, with 44, 60, and 42 patients undergoing a repeat mTESE after <3 months (group I), between 3 and 6 months (group II), and >6 months (group III) after the first procedure, respectively.
No significant differences were observed between groups in terms of patient characteristics and preoperative hormone profiles. Overall sperm retrieval rates did not differ among the three groups (93.2%, 90.0%, and 88.1% in groups I, II, and III, respectively [ p = 0.719]), nor did fertility outcomes, including rates of fertilization, biochemical pregnancy, clinical pregnancy, and cumulative live births.
Sperm retrieval rates for repeat mTESE procedures were consistently high, even when the second procedure was performed within 6 months of the first. Repeat mTESE within 6 months is not a limitation for patients with NOA, if required clinically.
显微切割睾丸取精术（mTESE）是治疗非梗阻性无精子症（NOA）男性患者获取精子的主要方法。一些专家认为，两次手术之间需要≥6个月的休息期，以确保更高的精子获取率和更少的并发症。然而，尚无科学研究探讨患者在安排第二次mTESE手术前应等待多长时间。本回顾性研究旨在评估在6个月内进行重复mTESE手术是否仍能取得良好的成功率。
回顾性收集了2012年5月至2019年9月期间146例同一睾丸接受两次mTESE手术的NOA患者。根据两次mTESE手术之间的时间间隔，将这些患者分为三组，分别有44例、60例和42例患者在第一次手术后<3个月（I组）、3至6个月（II组）和>6个月（III组）接受重复mTESE手术。
三组患者的特征和术前激素水平无显著差异。三组的总体精子获取率无差异（I组、II组和III组分别为93.2%、90.0%和88.1%[p = 0.719]），生育结局也无差异，包括受精率、生化妊娠率、临床妊娠率和累积活产率。
即使第二次手术在第一次手术后6个月内进行，重复mTESE手术的精子获取率仍然很高。如果临床需要，6个月内重复mTESE手术对NOA患者不是限制。
