非梗阻性无精子症男性显微取精术后的短期激素变化：一项大型纵向前瞻性多中心研究的结果

Short-Term Hormonal Changes Following Microdissection Testicular Sperm Extraction among Men with Non-Obstructive Azoospermia: Findings from a Large Longitudinal Prospective Multicentric Study.

作者信息

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

机构信息

Vita-Salute San Raffaele University, Milan, Italy.

Department of Urology, IRCCS Ospedale San Raffaele, Milan, Italy.

出版信息

World J Mens Health. 2024 Nov 27. doi: 10.5534/wjmh.240184.

DOI:10.5534/wjmh.240184

PMID:39743218

Abstract

PURPOSE

We aimed to investigate possible hormonal changes following microdissection testicular sperm extraction (mTESE) in men with non-obstructive azoospermia (NOA) across three referral centers.

MATERIALS AND METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

摘要

目的

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。

材料与方法

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。

结果

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）。