Combined Trifocal and Microsurgical Testicular Sperm Extraction Is the Best Technique for Testicular Sperm Retrieval in ¡°Low-Chance¡± Nonobstructive Azoospermia

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• 作者：Marcelo Marconi ; Andreas Keudel ; Thorsten Diemer ; Martin Bergmann ; Klaus Steger ; Hans-Christian Schuppe ; Wolfgang Weidner
• 关键词：Nonobstructive azoospermia (NOA) ; Male infertility ; Trifocal testicular sperm extraction (TESE) ; Microsurgical testicular sperm extraction (M-TESE)
• 刊名：European Urology
• 出版年：2012
• 出版时间：October, 2012
• 年：2012
• 卷：62
• 期：4
• 页码：713-719
• 全文大小：1149 K

文摘

Background

There is no consensus for the best testicular sperm extraction (TESE) technique in patients with ¡°low-chance¡± nonobstructive azoospermia (NOA).

Objective

To determine sperm retrieval rates in an intraindividual comparison using three locations of the testicle with and without the assistance of a microscope (microsurgical TESE [M-TESE]).

Design, setting, and participants

A series of 65 patients with low-chance NOA presenting with low testicular volume (<8 ml) and high serum follicle-stimulating hormone (FSH) (>12.4 IU/l) underwent trifocal-TESE plus M-TESE bilaterally (four biopsies per testis).

Intervention

Sperm retrieval was performed as trifocal-TESE (upper, middle, and lower testicular pole) with and without the assistance of a microscope in the middle incision.

Outcome measurements and statistical analysis

The number of evaluated tubules, the mean spermatogenetic scores, and the sperm retrieval rates were evaluated to determine retrieval locations and the use of the microscope. The Friedman and Cochrane Q tests were applied to determine statistical differences. Receiver operating characteristic curves were used for the analysis of serum FSH and testicular volume as preoperative prognostic factors.

Results and limitations

The sperm retrieval success of 66.2 % using the combined technique, meaning the percentage of patients with at least one tubule containing elongated spermatids, was the highest in the combination of trifocal- and M-TESE (p < 0.01), indicating this technique as optimal for patients with low-chance NOA. M-TESE and trifocal-TESE alone were not significantly better. The mean spermatogenetic score giving the number of tubules with elongated spermatids in relation to all tubules was significantly higher in M-TESE versus conventional TESE (p < 0.01), indicating the superior quality of the tissue harvested using the microscope. These results are limited by the definition of ¡°success¡± using ¡°one¡± spermatid/tubule. Preoperatively, high serum FSH and low testicular volumes did not exclude successful sperm retrieval.

Conclusions

The combination of trifocal- and M-TESE is the best technique to reach high sperm retrieval rates in patients with low-chance NOA.