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非梗阻性无精子症男性手术取精后睾酮水平的变化：系统评价与荟萃分析

Changes in Testosterone Levels Following Surgical Sperm Retrieval in Men with Non-Obstructive Azoospermia: Systematic Review and Meta-Analysis.

作者信息

Zohdy Wael, Shah Rupin, Ho Christopher Chee Kong, Calik Gokhan, Malhotra Vineet, Erkan Bircan Kolbaşı, Duran Mesut Berkan, Tsampoukas Georgios, Radion Garaz, Saleh Ramadan, Harraz Ahmed M, Kavoussi Parviz, Chung Eric, Ko Edmund, Boeri Luca, Kumar Naveen, Çayan Selahittin, Rambhatla Amarnath, Rajmil Osvaldo, Arafa Mohamed, Cannarella Rossella, Raheem Omer, Mostafa Taymour, Atmoko Widi, Hamoda Taha Abo-Almagd Abdel-Meguid, Zini Armand, Agarwal Ashok

机构信息

Department of Andrology, Sexology & STIs, Faculty of Medicine, Cairo University, Cairo, Egypt.

Global Andrology Forum, Moreland Hills, OH, USA.

出版信息

World J Mens Health. 2025 Jul;43(3):523-538. doi: 10.5534/wjmh.240129. Epub 2024 Sep 10.

DOI:10.5534/wjmh.240129
PMID:39344115
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12257322/
Abstract

PURPOSE

Surgical sperm retrieval (SSR) is used to extract spermatozoa for use with intracytoplasmic sperm injection in men with obstructive and non-obstructive azoospermia (NOA). The procedure may lead to segmental devascularization, postoperative fibrosis, and atrophy with a subsequent decrease in testosterone. The aim of the study is to investigate the impact of SSR on serum levels of total testosterone (TT), follicle-stimulating hormone (FSH), luteinizing hormone (LH) testicular volume, and sexual function in infertile azoospermic men.

MATERIALS AND METHODS

In this systematic review and meta-analysis (SRMA), we searched articles in "PubMed" and "Scopus" exploring the impact of SSR on TT, FSH, LH, and testicular volume. The full-text articles were screened to assess eligibility before data extraction, quality assessment, and meta-analysis.

RESULTS

Seventeen studies meeting the inclusion criteria were finally analyzed and included 1,685 infertile, azoospermic men. Patients underwent SSR and were followed in the postoperative period (one week to 32 months). The analysis showed a significant reduction in TT (mean difference [MD] 3.81 nmol/L, 95% confidence interval [CI] 0.55:7.06; p=0.02) compared to pre-SSR values. We also observed insignificant differences in serum FSH (MD 5.08 IU/L, 95% CI -5.6:15.8; p=0.35), LH (MD -2.96 IU/L, 95% CI -6.31:0.39; p=0.08), and no change in testicular volume (MD 0.07 mL, 95% CI -1.92:2.07; p=0.94) after SSR. Sexual dysfunction was associated with hypogonadism, depression, and anxiety, especially in men with unsuccessful SSR and Klinefelter syndrome.

CONCLUSIONS

The results of this SRMA indicate a significant reduction in TT after SSR. Sexual dysfunction after testicular sperm extraction and the potential negative impact of future SSR repeat should be considered during preoperative counseling.

摘要

目的

手术取精（SSR）用于为梗阻性和非梗阻性无精子症（NOA）男性提取精子，以用于胞浆内单精子注射。该手术可能导致局部血管化缺失、术后纤维化和萎缩，进而使睾酮水平降低。本研究旨在探讨SSR对不育无精子症男性血清总睾酮（TT）、促卵泡激素（FSH）、促黄体生成素（LH）、睾丸体积和性功能的影响。

材料与方法

在本系统评价和荟萃分析（SRMA）中，我们在“PubMed”和“Scopus”中检索了探讨SSR对TT、FSH、LH和睾丸体积影响的文章。在进行数据提取、质量评估和荟萃分析之前，对全文进行筛选以评估其是否符合纳入标准。

结果

最终分析了17项符合纳入标准的研究，纳入了1685例不育无精子症男性。患者接受了SSR手术，并在术后进行随访（1周至32个月）。分析显示，与SSR术前值相比，TT显著降低（平均差值[MD]3.81 nmol/L，95%置信区间[CI]0.55:7.06；p=0.02）。我们还观察到，SSR术后血清FSH（MD 5.08 IU/L，95% CI -5.6:15.8；p=0.35）、LH（MD -2.96 IU/L，95% CI -6.31:0.39；p=0.08）差异无统计学意义，睾丸体积无变化（MD 0.07 mL，95% CI -1.92:2.07；p=0.94）。性功能障碍与性腺功能减退、抑郁和焦虑有关，尤其是在SSR手术未成功的男性和克氏综合征患者中。

结论

本SRMA的结果表明，SSR术后TT显著降低。在术前咨询过程中，应考虑睾丸取精后性功能障碍以及未来重复进行SSR的潜在负面影响。

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Is testicular microdissection the only way to retrieve sperm for non-obstructive azoospermic men?睾丸显微解剖是为非梗阻性无精子症男性获取精子的唯一方法吗？
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