在大多数非梗阻性无精子症患者中，需要对整个睾丸实质进行完整解剖，以获得足够数量的高质量睾丸精子用于 ICSI。

A complete dissection of the whole testicular parenchyma is required in most patients with nonobstructive azoospermia to obtain enough good quality testicular spermatozoa for ICSI.

机构信息

Asl Bari, Reproductive Unit, Andrology Outpatients Clinic, PTA "F Jaia,", Conversano, Italy.

Next Fertility Procrea, Andrology Unit, Lugano, Switzerland.

出版信息

Andrology. 2023 Mar;11(3):508-514. doi: 10.1111/andr.13344. Epub 2022 Dec 9.

DOI:10.1111/andr.13344

PMID:36416145

Abstract

BACKGROUND

Due to the heterogeneous distribution of seminiferous tubules (STs) in patients with nonobstructive azoospermia (NOA), retrieving enough good quality spermatozoa for ICSI may require a complete testicular dissection. According to the only available study in this field, spermatozoa may be found in the testis surface in 34.2% of patients, while a deeper testicular dissection is able to provide spermatozoa for ICSI in 28% of those without spermatozoa in the testis surface.

OBJECTIVES

To determine the probability of finding enough spermatozoa for ICSI at the initial wide incision of the testis in a cohort of men with NOA undergoing microdissection testicular spermatozoa extraction (mTESE).

MATERIALS AND METHODS

We evaluated 276 patients, aged 37 (20-62) years, who underwent unilateral (86, 31.15%) or bilateral (190, 68.8%) mTESE from January 2018 through December 2021. During mTESE, the entire surface of the testicular parenchyma was explored first in search for dilated STs: if no/ not enough spermatozoa were retrieved, the deeper portion of the parenchyma was explored.

RESULTS

Spermatozoa were retrieved in 137 patients (49.6%). Histopathology demonstrated Sertoli-cell only syndrome in 65.6% of operated testes, while maturation arrest was found in 19.5%, hypospermatogenesis (HS) in 12.7%, and hyalinosis in 2%. Spermatozoa were obtained from the testis surface in 46 of 276 patients (16.6%), and after a complete dissection in 91 subjects (32.9%). On multivariate logistic regression, only the histopathological subcategory HS was predictive of the chance of retrieving spermatozoa from the surface of the testis (OR 3.24, 95% CI 1.37-7.69, p = 0.007).

DISCUSSION

Most patients with NOA, particularly those with unfavorable histopathological patterns, require a complete dissection of the testicular parenchyma to obtain enough good quality for ICSI.

CONCLUSIONS

By enabling the complete exploration of the testicular parenchyma, mTESE is to be preferred to cTESE to retrieve spermatozoa in patients with NOA.

摘要

背景

由于非梗阻性无精子症（NOA）患者的生精小管（ST）分布不均，为了进行 ICSI，可能需要对睾丸进行完整的解剖以获取足够数量和质量的精子。根据该领域唯一的研究，在 34.2%的患者中，精子可能存在于睾丸表面，而在那些睾丸表面没有精子的患者中，进行更深入的睾丸解剖可以为 ICSI 提供精子。

目的

确定在接受显微镜睾丸精子提取术（mTESE）的 NOA 男性队列中，通过初始广泛切开睾丸找到足够数量的精子用于 ICSI 的概率。

材料和方法

我们评估了 2018 年 1 月至 2021 年 12 月期间接受单侧（86 例，31.15%）或双侧（190 例，68.8%）mTESE 的 276 例患者，年龄 37（20-62）岁。在 mTESE 过程中，首先探索整个睾丸实质的表面以寻找扩张的 ST：如果未/未获得足够的精子，则进一步探索实质的深部。

结果

137 例患者（49.6%）获得精子。组织病理学显示，手术睾丸中 Sertoli 细胞仅综合征占 65.6%，而成熟阻滞占 19.5%，精子发生不全（HS）占 12.7%，玻璃样变占 2%。276 例患者中有 46 例（16.6%）在睾丸表面获得精子，91 例（32.9%）在完全解剖后获得精子。多变量逻辑回归分析仅发现组织病理学亚类 HS 是预测从睾丸表面获得精子的可能性的因素（OR 3.24，95%CI 1.37-7.69，p=0.007）。