دورية أكاديمية
أعرض في EDS

Intrasurgical parameters associated with successful sperm retrieval in patients with non-obstructive azoospermia undergoing salvage microdissection testicular sperm extraction.

التفاصيل البيبلوغرافية
العنوان: Intrasurgical parameters associated with successful sperm retrieval in patients with non-obstructive azoospermia undergoing salvage microdissection testicular sperm extraction.
المؤلفون: Caroppo E; Asl Bari, PTA F Jaia, Andrology Outpatient Clinic, Bari, Italy., Castiglioni F; Procrea Institute, Andrology Unit, Lugano, Switzerland., Campagna C; Procrea Institute, Andrology Unit, Lugano, Switzerland., Colpi EM; Procrea Institute, Andrology Unit, Lugano, Switzerland., Piatti E; Procrea Institute, Andrology Unit, Lugano, Switzerland., Gazzano G; Division of Anatomic Pathology, Istituto Auxologico Italiano (IRCCS), Milano, Italy., Colpi GM; Procrea Institute, Andrology Unit, Lugano, Switzerland.
المصدر: Andrology [Andrology] 2021 Nov; Vol. 9 (6), pp. 1864-1871. Date of Electronic Publication: 2021 Jul 26.
نوع المنشور: Evaluation Study; Journal Article
اللغة: English
بيانات الدورية: Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 101585129 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2047-2927 (Electronic) Linking ISSN: 20472919 NLM ISO Abbreviation: Andrology Subsets: MEDLINE
أسماء مطبوعة: Original Publication: Oxford : Wiley-Blackwell, 2013-
مواضيع طبية MeSH: Azoospermia/*surgery , Microdissection/*methods , Salvage Therapy/*methods , Sperm Retrieval/*statistics & numerical data , Testis/*surgery, Adult ; Clinical Decision Rules ; Humans ; Intraoperative Period ; Male ; Middle Aged ; Retrospective Studies ; Seminiferous Tubules/surgery ; Treatment Outcome
مستخلص: Background: Patients with non-obstructive azoospermia with a previously failed conventional testicular sperm extraction may undergo a salvage microdissection testicular sperm extraction with the probability of successful sperm retrieval being almost dependent upon the number of previous surgical attempts and to different histopathologic categories.
Objectives: To determine whether the seminiferous tubules pattern and the histological categories could affect the sperm retrieval rate in patients with non-obstructive azoospermia undergoing salvage microdissection testicular sperm extraction after failed conventional testicular sperm extraction.
Materials and Methods: Seventy-nine patients undergoing unilateral or bilateral salvage microdissection testicular sperm extraction were evaluated. During microdissection testicular sperm extraction, if present, dilated tubules were retrieved, otherwise, tubules with slightly larger caliber than that of the surroundings were removed. When no dilated tubule or tubule with slightly larger caliber was found, not dilated tubules were excised. A prediction model was built with seminiferous tubules pattern and testis histology as covariates.
Results: Sperm retrieval was successful in 30 out of 79 patients. The prediction model correctly classified 88.3% of cases, explained the 29.7% variability of the outcome, and significantly predicted the microdissection testicular sperm extraction outcome with a sensitivity of 67.7% and a specificity of 90.2%, Both tubules with slightly larger caliber and not dilated tubules were negatively associated with the chance of retrieving spermatozoa. Among the histological categories, only early maturation arrest was significant to the model (log(SSR) = 0.57 - 1.9SDT - 3.3NDT - 1.76EMA) (where SSR is sperm retrieval rate, SDT is tubule with slightly larger caliber, NDT is not dilated tubule, and EMA is early maturation arrest). The model had a clearly useful discrimination (area under the curve = 0.814), the estimated performance was 0.8105, and internal calibration was acceptable (p > 0.05).
Discussion: Seminiferous tubules pattern and testis histology may reliably explain the salvage microdissection testicular sperm extraction outcome in all patients with non-obstructive azoospermia apart from those with early maturation arrest, where the homogeneous apparent seminiferous tubules pattern may be misleading.
Conclusion: The outcome of salvage microdissection testicular sperm extraction can be predicted by the same intrasurgical parameters that have been demonstrated to predict the outcome of microdissection testicular sperm extraction in naïve patients with non-obstructive azoospermia.
(© 2021 American Society of Andrology and European Academy of Andrology.)
References: Bernie AM, Mata D, Ramasamy R, Schlegel PN. Comparison of microdissection testicular sperm extraction, conventional testicular sperm extraction, and testicular sperm aspiration for nonobstructive azoospermia: a systematic review and meta-analysis. Fertil Steril. 2015;104:1099-1103.
Ramasamy R, Schlegel PN. Microdissection testicular sperm extraction: effect of prior biopsy on success of sperm retrieval. J Urol. 2007;4:1447-1449.
Hussein A. Evaluation of diagnostic testis biopsy and the repetition of testicular sperm extraction surgeries in infertility patients. Fertil Steril. 2013;100:88-93.
Caroppo E, Colpi EM, Gazzano G, et al. The seminiferous tubule caliber pattern as evaluated at high magnification during microdissection testicular sperm extraction predicts sperm retrieval in patients with non-obstructive azoospermia. Andrology. 2019;7:8-14.
Tash JA, Schlegel PN. Histologic effects of testicular sperm extraction on the testicle in men with nonobstructive azoospermia. Urology. 2001;57:334-337.
Herwig R, Tosun K, Pinggera GM, et al. Tissue perfusion essential for spermatogenesis and outcome of testicular sperm extraction (TESE) for assisted reproduction. J Assist Reprod Genet. 2004;21:175-180.
Moons KGM, Altman DG, Reitsma JB, et al. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): explanation and elaboration. Ann Intern Med. 2015;162:W1-W73.
Smith GC, Seaman SR, Wood AM, Royston P, White IR. Correcting for optimistic prediction in small data sets. Am J Epidemiol. 2014;180(3):318-324.
Finazzi S, Poole D, Luciani D, Cogo PE, Bertolini G. Calibration belt for quality-of-care assessment based on dichotomous outcomes. PLoS One. 2011;6:e16110.
Nattino G, Finazzi S, Bertolini G. A new test and graphical tool to assess the goodness of fit of logistic regression models. Stat Med. 2016;35:709-720.
Bernie AM, Shah K, Halpern JA, et al. Outcomes of microdissection testicular sperm extraction in men with nonobstructive azoospermia due to maturation arrest. Fertil Steril. 2015;104:569-573.
Weedin JW, Bennet RC, Fenig DM, Lamb DJ, Lipshultz LI. Early versus late maturation arrest: reproductive outcomes of testicular failure. J Urol. 2011;186:621-626.
Tsujimura A, Miyagawa Y, Takao T, et al. Salvage microdissection testicular sperm extraction after failed conventional testicular sperm extraction in patients with nonobstructive azoospermia. J Urol. 2006;175:1446-1449.
Kalsi JS, Shah P, Thum Y, Muneer A, Ralph DJ, Minhas S. Salvage micro-dissection testicular sperm extraction; outcome in men with non-obstructive azoospermia with previous failed sperm retrievals. BJU Int. 2015;116:460-465.
Xu T, Peng L, Lin X, li J, Xu W. Predictors for successful sperm retrieval of salvage microdissection testicular sperm extraction (TESE) following failed TESE in nonobstructive azoospermia patients. Andrologia. 2017;49. https://doi.org/10.1111/and.12642.
Schlegel PN. Perspectives on repeat sperm retrieval in nonobstructive azoospermia. Fertil Steril. 2013;100:60.
Schlegel PN. The importance of microdissection testicular sperm extraction intervention after prior failed nonobstructive azoospermia treatment. Fertil Steril. 2021;115:881. https://doi.org/10.1016/j.fertnstert.2021.01.052.
Kato Y, Shiraishi K, Matsuyama H. Expression of testicular androgen receptor in non-obstructive azoospermia and its change after hormonal therapy. Andrology. 2014;2:734-740.
Shiraishi K, Ishikawa T, Watanabe N, Iwamoto T, Matsuyama H. Salvage hormonal therapy after failed microdissection testicular sperm extraction: a multi-institutional prospective study. Int J Urol. 2016;23:496-500.
Schlegel PN, Sigman M, Collura B, et al. Diagnosis and treatment of infertility in men: AUA/ASRM guideline part II. Fertil Steril. 2020;115:62-69.
Caroppo E, Colpi GM. Hormonal treatment of men with nonobstructive azoospermia: what does the evidence suggest? J Clin Med. 2021;10:387.
Colpi GM, Caroppo E. Re: predictors of surgical sperm retrieval in non-obstructive azoospermia: summary of current literature. Int Urol Nephrol. 2020;52:2039-2041.
Jarvis S, Yee HK, Thomas N, et al. Sperm fine-needle aspiration (FNA) mapping after failed microdissection testicular sperm extraction (TESE): location and patterns of found sperm. Asian J Androl. 2018;21:50-55.
Janosek-Albright KJC, Schlegel PN, Dabaja AA. Testis sperm extraction. Asian J Urol. 2015;2:79-84.
Shufaro Y, Prus D, Laufer N, Simon A. Impact of repeated testicular fine needle aspirations (TEFNA) and testicular sperm extraction (TESE) on the microscopic morphology of the testis: an animal model. Hum Reprod. 2002;17:1795-1799.
Ramasamy R, Reifsnyder JE, Husseini H, Eid PA, Bryson C, Schlegel PN. Localization of sperm during microdissection testicular sperm extraction in men with non-obstructive azoospermia. J Urol. 2013;189:643-646.
فهرسة مساهمة: Keywords: male infertility; non-obstructive azoospermia; salvage mTESE; seminiferous tubules; sperm retrieval; testis histology
تواريخ الأحداث: Date Created: 20210721 Date Completed: 20220301 Latest Revision: 20220301
رمز التحديث: 20240628
DOI: 10.1111/andr.13082
PMID: 34289247
قاعدة البيانات: MEDLINE
الوصف
تدمد:2047-2927
DOI:10.1111/andr.13082