Negri Fausto, Pozzi Edoardo, Corsini Christian, Raffo Massimiliano, Belladelli Federico, Bertini Alessandro, Cattafi Francesco, Ventimiglia Eugenio, Matloob Rayan, Saccà Antonino, Boeri Luca, d'Arma Alessia, Montorsi Francesco, Salonia Andrea
Vita-Salute San Raffaele University, Milan, Italy.
Department of Urology, IRCCS Ospedale San Raffaele, Milan, Italy.
World J Mens Health. 2024 Nov 27. doi: 10.5534/wjmh.240184.
We aimed to investigate possible hormonal changes following microdissection testicular sperm extraction (mTESE) in men with non-obstructive azoospermia (NOA) across three referral centers.
We prospectively analyzed data from 102 consecutive NOA men. Patients with prior hormonal therapies were excluded. Preoperative serum hormone levels (total testosterone [tT], luteinizing hormone [LH], follicle-stimulating hormone [FSH], and 17β-estradiol) were collected, with repeat measurements at 3-month post-surgery. We divided the cohort into two groups using a tT cut-off value of 3 ng/mL: 1) men who kept eugonadal status; and, 2) men who were initially eugonadal but became testosterone deficient (TD) after surgery.
Overall, median (interquartile range [IQR]) age was 37 years (32-40 years). Positive sperm retrieval during mTESE was observed in 34 (33.3%) patients, and 48 (47.1%) underwent bilateral mTESE. Compared to baseline, 3-month postoperative median (IQR) hormonal levels were as follows: tT: 3.71 ng/mL (2.76-5.24 ng/mL) 4.27 ng/mL (3.25-6.07 ng/mL), p=0.32; FSH: 22.0 mIU/mL (12.65-31.47 mIU/mL) 19.5 mIU/mL (11.63-25.8 mIU/mL), p=0.25; LH: 9.0 mIU/mL (5.11-12.4 mIU/mL) 7.6 mIU/mL (5.04-13.4 mIU/mL), p=0.73, respectively. Twelve (13.5%) eugonadal men at baseline showed TD after mTESE. Median (IQR) tT values at baseline and 3-month follow-up were compared between those who preserved eugonadal status after surgery and those who became TD after surgery: baseline levels were 4.46 ng/mL (4.1-6.27 ng/mL) 4.14 ng/mL (3.24-4.98 ng/mL), p=0.09; and, 3-month follow-up levels were 4.58 ng/mL (3.58-5.56 ng/mL) 2.51 ng/mL (2.31-2.76 ng/mL), p<0.001, respectively. Men who developed TD had lower testicular volume (TV) (6 [4-10] vs. 10 [8-12.25] Prader, p=0.001) and karyotype abnormalities (4 [33.3] 1 [1.3], p=0.006).
This multicentric study shows that mTESE in men with NOA does not significantly impact short-time postoperative follow-up tT, LH, and FSH levels. A substantial proportion of men who were initially eugonadal demonstrated tT suggestive for TD at 3-month follow-up. These men had lower TV at baseline and abnormal karyotype.
我们旨在调查三个转诊中心中患有非梗阻性无精子症（NOA）的男性在显微切割睾丸取精术（mTESE）后可能出现的激素变化。
我们前瞻性地分析了102例连续的NOA男性的数据。排除先前接受过激素治疗的患者。收集术前血清激素水平（总睾酮[tT]、黄体生成素[LH]、卵泡刺激素[FSH]和17β-雌二醇），并在术后3个月进行重复测量。我们使用3 ng/mL的tT临界值将队列分为两组：1）维持性腺功能正常状态的男性；2）最初性腺功能正常但术后出现睾酮缺乏（TD）的男性。
总体而言，中位（四分位间距[IQR]）年龄为37岁（32 - 40岁）。34例（33.3%）患者在mTESE期间成功取到精子，48例（47.1%）接受了双侧mTESE。与基线相比，术后3个月的中位（IQR）激素水平如下：tT：3.71 ng/mL（2.76 - 5.24 ng/mL）对4.27 ng/mL（3.25 - 6.07 ng/mL），p = 0.32；FSH：22.0 mIU/mL（12.65 - 31.47 mIU/mL）对19.5 mIU/mL（11.63 - 25.8 mIU/mL），p = 0.25；LH：9.0 mIU/mL（5.11 - 12.4 mIU/mL）对7.6 mIU/mL（5.04 - 13.4 mIU/mL），p = 0.73。12例（13.5%）基线时性腺功能正常的男性在mTESE后出现TD。比较术后维持性腺功能正常状态的男性和术后出现TD的男性在基线和3个月随访时的中位（IQR）tT值：基线水平为4.46 ng/mL（4.1 - 6.27 ng/mL）对4.14 ng/mL（3.24 - 4.98 ng/mL），p = 0.09；3个月随访水平为4.58 ng/mL（3.58 - 5.56 ng/mL）对2.51 ng/mL（2.31 - 2.76 ng/mL），p < 0.001。出现TD的男性睾丸体积（TV）较小（6 [4 - 10] Prader对10 [8 - 12.25] Prader，p = 0.001）且核型异常（4 [33.3%]对1 [1.3%]，p = 0.006）。
这项多中心研究表明，NOA男性的mTESE对术后短期随访的tT、LH和FSH水平没有显著影响。相当一部分最初性腺功能正常的男性在3个月随访时出现提示TD的tT水平。这些男性基线时TV较小且核型异常。
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