Rambhatla Amarnath, Shah Rupin, Ziouziou Imad, Kothari Priyank, Salvio Gianmaria, Gul Murat, Hamoda Taha, Kavoussi Parviz, Atmoko Widi, Toprak Tuncay, Birowo Ponco, Ko Edmund, Arafa Mohamed, Ghayda Ramy Abou, Karthikeyan Vilvapathy Senguttuvan, Russo Giorgio Ivan, Pinggera Germar-Michael, Chung Eric, Harraz Ahmed M, Martinez Marlon, Phuoc Nguyen Ho Vinh, Tadros Nicholas, Saleh Ramadan, Savira Missy, Colpi Giovanni M, Zohdy Wael, Pescatori Edoardo, Park Hyun Jun, Fukuhara Shinichiro, Tsujimura Akira, Rojas-Cruz Cesar, Marino Angelo, Mak Siu King, Amar Edouard, Ibrahim Wael, Sindhwani Puneet, Alhathal Naif, Busetto Gian Maria, Al Hashimi Manaf, El-Sakka Ahmed, Ramazan Asci, Dimitriadis Fotios, Timpano Massimiliano, Jezek Davor, Altay Baris, Zylbersztejn Daniel Suslik, Wong Michael Yc, Moon Du Geon, Wyns Christine, Gamidov Safar, Akhavizadegan Hamed, Franceschelli Alessandro, Aydos Kaan, Quang Nguyen, Ashour Shedeed, Al Dayel Adel, Al-Marhoon Mohammed S, Micic Sava, Binsaleh Saleh, Hussein Alayman, Elbardisi Haitham, Mostafa Taymour, Ramsay Jonathan, Zachariou Athanasios, Abdelrahman Islam Fathy Soliman, Rajmil Osvaldo, Kalkanli Arif, Molina Juan Manuel Corral, Bocu Kadir, Duarsa Gede Wirya Kusuma, Çeker Gökhan, Serefoglu Ege Can, Bahar Fahmi, Gherabi Nazim, Kuroda Shinnosuke, Bouzouita Abderrazak, Gudeloglu Ahmet, Ceyhan Erman, Hasan Mohamed Saeed Mohamed, Musa Muhammad Ujudud, Motawi Ahmad, Cho Chak-Lam, Taniguchi Hisanori, Ho Christopher Chee Kong, Vazquez Jesus Fernando Solorzano, Mutambirwa Shingai, Gungor Nur Dokuzeylul, Bendayan Marion, Giulioni Carlo, Baser Aykut, Falcone Marco, Boeri Luca, Blecher Gideon, Kheradmand Alireza, Sethupathy Tamilselvi, Adriansjah Ricky, Narimani Nima, Konstantinidis Charalampos, Nguyen Tuan Thanh, Japari Andrian, Dolati Parisa, Singh Keerti, Ozer Cevahir, Sarikaya Selcuk, Sheibak Nadia, Bosco Ndagijimana Jean, Özkent Mehmet Serkan, Le Sang Thanh, Sokolakis Ioannis, Katz Darren, Smith Ryan, Truong Manh Nguyen, Le Tan V, Huang Zhongwei, Deger Muslim Dogan, Arslan Umut, Calik Gokhan, Franco Giorgio, Rashed Ayman, Kahraman Oguzhan, Andreadakis Sotiris, Putra Rosadi, Balercia Giancarlo, Khalafalla Kareim, Cannarella Rossella, Tuấn Anh Đặng, El Meliegy Amr, Zilaitiene Birute, Ramirez Marlene Lizbeth Zamora, Giacone Filippo, Calogero Aldo E, Makarounis Konstantinos, Jindal Sunil, Hoai Bac Nguyen, Banthia Ravi, Peña Marcelo Rodriguez, Moorthy Dharani, Adamyan Aram, Kulaksiz Deniz, Kandil Hussein, Sofikitis Nikolaos, Salzano Ciro, Jungwirth Andreas, Banka Surendra Reddy, Mierzwa Tiago Cesar, Turunç Tahsin, Jain Divyanu, Avoyan Armen, Salacone Pietro, Kadıoğlu Ateş, Gupta Chirag, Lin Haocheng, Shamohammadi Iman, Mogharabian Nasser, Barrett Trenton, Danacıoğlu Yavuz Onur, Crafa Andrea, Daoud Salima, Malhotra Vineet, Almardawi Abdulmalik, Selim Osama Mohamed, Moussa Mohamad, Haghdani Saeid, Duran Mesut Berkan, Kunz Yannic, Preto Mirko, Eugeni Elena, Nguyen Thang, Elshahid Ahmed Rashad, Suyono Seso Sulijaya, Parikesit Dyandra, Nada Essam, Orozco Eduardo Gutiérrez, Boitrelle Florence, Trang Nguyen Thi Minh, Jamali Mounir, Nair Raju, Ruzaev Mikhail, Gadda Franco, Thomas Charalampos, Ferreira Raphael Henrique, Gul Umit, Maruccia Serena, Kanbur Ajay, Kinzikeeva Ella, Abumelha Saad Mohammed, Kosgi Raghavender, Gokalp Fatih, Soebadi Mohammad Ayodhia, Paul Gustavo Marquesine, Sajadi Hesamoddin, Gupte Deepak, Ambar Rafael F, Sogutdelen Emrullah, Singla Karun, Basukarno Ari, Kim Shannon Hee Kyung, Gilani Mohammad Ali Sadighi, Nagao Koichi, Brodjonegoro Sakti Ronggowardhana, Rezano Andri, Elkhouly Mohamed, Mazzilli Rossella, Farsi Hasan M A, Ba Hung Nguyen, Alali Hamed, Kafetzis Dimitrios, Long Tran Quang Tien, Alsaid Sami, Cuong Hoang Bao Ngoc, Oleksandr Knigavko, Mustafa Akhmad, Acosta Herik, Pai Hrishikesh, Şahin Bahadır, Arianto Eko, Teo Colin, Jayaprakash Sanjay Prakash, Rachman Rinaldo Indra, Yenice Mustafa Gurkan, Sefrioui Omar, Priyadarshi Shivam, Tanic Marko, Alfatlaw Noor Kareem, Rizaldi Fikri, Vishwakarma Ranjit B, Kanakis George, Cherian Dinesh Thomas, Lee Joe, Galstyan Raisa, Keskin Hakan, Wurzacher Janan, Seno Doddy Hami, Noegroho Bambang S, Margiana Ria, Javed Qaisar, Castiglioni Fabrizio, Tanwar Raman, Puigvert Ana, Kaya Coşkun, Purnomo Medianto, Yazbeck Chadi, Amir Azwar, Borges Edson, Bellavia Marina, Deswanto Isaac Ardianson, Kv Vinod, Liguori Giovanni, Minh Dang Hoang, Siddiqi Kashif, Colombo Fulvio, Zini Armand, Patel Niket, Çayan Selahittin, Al-Kawaz Ula, Ragab Maged, Hebrard Guadalupe Hernández, de la Rosette Jean, Efesoy Ozan, Hoffmann Ivan, Teixeira Thiago Afonso, Saylam Barış, Delgadillo Daniela, Agarwal Ashok
Department of Urology, Henry Ford Health System, Vattikuti Urology Institute, Detroit, MI, USA.
Division of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India.
World J Mens Health. 2025 Jan;43(1):92-122. doi: 10.5534/wjmh.230339. Epub 2024 Apr 4.
Non-obstructive azoospermia (NOA) is a common, but complex problem, with multiple therapeutic options and a lack of clear guidelines. Hence, there is considerable controversy and marked variation in the management of NOA. This survey evaluates contemporary global practices related to medical and surgical management for patients with NOA.
A 56-question online survey covering various aspects of the evaluation and management of NOA was sent to specialists around the globe. This paper analyzes the results of the second half of the survey dealing with the management of NOA. Results have been compared to current guidelines, and expert recommendations have been provided using a Delphi process.
Participants from 49 countries submitted 336 valid responses. Hormonal therapy for 3 to 6 months was suggested before surgical sperm retrieval (SSR) by 29.6% and 23.6% of participants for normogonadotropic hypogonadism and hypergonadotropic hypogonadism respectively. The SSR rate was reported as 50.0% by 26.0% to 50.0% of participants. Interestingly, 46.0% reported successful SSR in <10% of men with Klinefelter syndrome and 41.3% routinely recommended preimplantation genetic testing. Varicocele repair prior to SSR is recommended by 57.7%. Half of the respondents (57.4%) reported using ultrasound to identify the most vascularized areas in the testis for SSR. One-third proceed directly to microdissection testicular sperm extraction (mTESE) in every case of NOA while others use a staged approach. After a failed conventional TESE, 23.8% wait for 3 months, while 33.1% wait for 6 months before proceeding to mTESE. The cut-off of follicle-stimulating hormone for positive SSR was reported to be 12-19 IU/mL by 22.5% of participants and 20-40 IU/mL by 27.8%, while 31.8% reported no upper limit.
This is the largest survey to date on the real-world medical and surgical management of NOA by reproductive experts. It demonstrates a diverse practice pattern and highlights the need for evidence-based international consensus guidelines.
非梗阻性无精子症（NOA）是一个常见但复杂的问题，有多种治疗选择且缺乏明确的指南。因此，在NOA的管理方面存在相当大的争议和显著差异。本调查评估了与NOA患者医学和手术管理相关的当代全球实践。
向全球专家发送了一份包含56个问题的在线调查问卷，内容涵盖NOA评估和管理的各个方面。本文分析了调查后半部分关于NOA管理的结果。将结果与当前指南进行了比较，并采用德尔菲法提供了专家建议。
来自49个国家的参与者提交了336份有效回复。分别有29.6%和23.6%的参与者建议在手术取精（SSR）前对正常促性腺激素性性腺功能减退和高促性腺激素性性腺功能减退患者进行3至6个月的激素治疗。26.0%至50.0%的参与者报告的SSR成功率为50.0%。有趣的是，46.0%的参与者报告克氏综合征男性中SSR成功率低于10%，41.3%的参与者常规推荐植入前基因检测。57.7%的人建议在SSR前进行精索静脉曲张修复。一半的受访者（57.4%）报告在SSR时使用超声识别睾丸中血管最丰富的区域。三分之一的人在每例NOA患者中直接进行显微切割睾丸取精（mTESE），而其他人采用分阶段方法。在传统TESE失败后，23.8%的人等待3个月，33.1%的人等待6个月再进行mTESE。22.5%的参与者报告SSR阳性的促卵泡激素临界值为12 - 19 IU/mL，27.8%的人报告为20 - 40 IU/mL，而31.8%的人报告没有上限。
这是迄今为止生殖专家对NOA实际医学和手术管理进行的最大规模调查。它展示了多样化的实践模式，并强调了基于证据的国际共识指南的必要性。
Zotero 插件
