Assessment of testicular perfusion prior to sperm extraction predicts success rate and decreases the number of required biopsies in patients with non-obstructive azoospermia

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• 作者：Mohammad Reza Nowroozi (1) (2)
  Mohsen Ayati (1)
  Erfan Amini (1)
  Kayvan Radkhah (1)
  Hassan Jamshidian (1)
  Asieh Delpazir (1)
  Faeze Ghasemi (1)
  Alireza Rajabzadeh Kanafi (1)
  
  1. Department of Urology ; Uro-Oncology Research Center ; Tehran University of Medical Sciences ; Tehran ; Iran
  2. Urology Research Center ; Tehran University of Medical Sciences ; Tehran ; Iran
  
• 关键词：Azoospermia ; Infertility ; Male ; Sperm retrieval ; Testis ; Ultrasonography ; Doppler
• 刊名：International Urology and Nephrology
• 出版年：2015
• 出版时间：January 2015
• 年：2015
• 卷：47
• 期：1
• 页码：53-58
• 全文大小：633 KB
• 参考文献：1. Devroey P, Liu J, Nagy Z, Goossens A, Tournaye H, Camus M, Van Steirteghem A, Silber S (1995) Pregnancies after testicular sperm extraction and intracytoplasmic sperm injection in non-obstructive azoospermia. Hum Reprod 10:1457鈥?460 CrossRef
  2. Belenky A, Avrech OM, Bachar GN, Zuckerman Z, Rafael ZBen, Fisch B, Cohen M (2001) Ultrasound-guided testicular sperm aspiration in azoospermic patients: a new sperm retrieval method for intracytoplasmic sperm injection. J Clin Ultrasound 29:339鈥?43 CrossRef
  3. Schlegel PN (1999) Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision. Hum Reprod 14:131鈥?35 CrossRef
  4. Takada S, Tsujimura A, Ueda T, Matsuoka Y, Takao T, Miyagawa Y, Koga M, Takeyama M, Okamoto Y, Matsumiya K, Fujioka H, Nonomura N, Okuyama A (2008) Androgen decline in patients with nonobstructive azoospemia after microdissection testicular sperm extraction. Urology 72:114鈥?18 CrossRef
  5. Deruyver Y, Vanderschueren D, Van der Aa F (2014) Outcome of microdissection TESE compared with conventional TESE in non-obstructive azoospermia: a systematic review. Andrology 2(1):20鈥?4 CrossRef
  6. Herwig R, Tosun K, Schuster A, Rehder P, Glodny B, Wildt L, Illmensee K, Pinggera GM (2007) Tissue perfusion-controlled guided biopsies are essential for the outcome of testicular sperm extraction. Fertil Steril 87:1071鈥?076 CrossRef
  7. Tunc L, Alkibay T, Kupeli B, Tokgoz H, Bozkirli I, Yucel C (2005) Power Doppler ultrasound mapping in nonobstructive azoospermic patients prior to testicular sperm extraction. Arch Androl 51:277鈥?83 CrossRef
  8. Herwig R, Tosun K, Pinggera GM, Soelder E, Moeller KT, Pallwein L, Frauscher E, Bartsch G, Wildt L, Illmensee K (2004) Tissue perfusion essential for spermatogenesis and outcome of testicular sperm extraction (TESE) for assisted reproduction. J Assist Reprod Genet 21:175鈥?80 CrossRef
  9. Battaglia C, Giulini S, Regnani G, Madgar I, Facchinetti F, Volpe A (2001) Intratesticular Doppler flow, seminal plasma nitrites/nitrates, and nonobstructive sperm extraction from patients with obstructive and nonobstructive azoospermia. Fertil Steril 75:1088鈥?094 CrossRef
  10. Souza CA, Cunha-Filho JS, Fagundes P, Freitas FM, Passos EP (2005) Sperm recovery prediction in azoospermic patients using Doppler ultrasonography. Int Urol Nephrol 37:535鈥?40 CrossRef
  11. Martinoli C, Derchi LE, Rizzatto G, Solbiati L (1998) Power Doppler sonography: general principles, clinical applications, and future prospects. Eur Radiol 8(7):1224鈥?235 CrossRef
  12. Foresta C, Garolla A, Bettella A, Ferlin A, Rossato M, Candiani F (1998) Doppler ultrasound of the testis in azoospermic subjects as a parameter of testicular function. Hum Reprod 13:3090鈥?093 CrossRef
  13. Eytan O, Har-Toov J, Fait G, Yavetz H, Hauser R, Yogev L, Botchan A, Ben-Yosef D, Elad D, Jaffa AJ (2001) Vascularity index distribution within the testis: a technique for guiding testicular sperm extraction. Ultrasound Med Biol 27:1171鈥?176 CrossRef
  14. Schill T, Bals-Pratsch M, Kupker W, Sandmann J, Johannisson R, Diedrich K (2003) Clinical and endocrine follow-up of patients after testicular sperm extraction. Fertil Steril 79:281鈥?86 CrossRef
  15. Schlegel PN, Li PS (1998) Microdissection TESE: sperm retrieval in non-obstructive azoospermia. Hum Reprod Update 4:439 CrossRef
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Nephrology
  Urology and Andrology
  
• 出版者：Springer Netherlands
• ISSN：1573-2584

文摘

Objectives To assess the role of power and color Doppler ultrasonography (US) in patients with azoospermia prior to testicular sperm extraction. Methods One hundred and thirty consecutive patients with azoospermia were assessed in this prospective study. Based on a semiquantitative method, the results of power Doppler US were graded into three categories: grade 1, no visible vessels; grade 2, between one and three detectable vessels; grade 3, more than three detectable vessels. The location of each visible vessel was also recorded as upper, middle or lower third of the testis. Results Seventy-four patients with non-obstructive azoospermia (NOA) and 27 with obstructive azoospermia (OA) fulfilled the study criteria. OA patients revealed a significantly higher intratesticular perfusion compared with NOA patients. NOA patients with higher intratesticular perfusion required fewer biopsies for successful sperm retrieval. Moreover, a correlation was noted between the presence of visible vessels in each segment and the probability of successful sperm retrieval during biopsy from the corresponding segment. Conclusions Our data indicate that a semiquantitative, simplified power Doppler US assessment is capable of localizing areas containing viable sperm with the potential to direct biopsies to specific sites and subsequent decrease in the number of required biopsies.