非鑲嵌型克林菲氏症在年齡較大的青少年因無精症進行睪丸取精的結果
翁涵育、林永明、鄭裕生
國立成功大學醫學院附設醫院泌尿部
The testicular sperm retrieval outcomes in older adolescents with non-mosaic Klinefelter syndrome and azoospermia
Han-Yu Weng, Yung-Ming Lin, Yu-Sheng Cheng
Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Purpose: The progressive germ cell depletion and testicular fibrosis are observed at peripubertal age in patients with Klinefelter syndrome (KS). This study aims to analyze the reproductive decisions, clinical characteristics, and the sperm retrieval rate (SRR) of older adolescents (age 15-19 years) with non-mosaic KS in an andrology clinic, and to evaluate the need for aggressive fertility preservation (FP)in older adolescentsby comprehensive literature review.
Materials and Methods: Older adolescents with non-mosaic KS referred for hypogonadism, and reproductive counseling were enrolled. Patients/parents who agreed testicular sperm retrieval were enrolled for subsequent SRR analysis. A comprehensive literature review regarding the SRR in older adolescents was conducted.
Results: A total of eight older adolescents were referred to our clinic. Three out of eight patients/parents (37.5%)agreed to undergo microdissection testicular sperm extraction (mTESE). Spermatozoa were successfully retrieved in two patients (66.7%), and histopathological diagnosis showed two patients with Sertoli cell-only syndrome and one patient with hypospermatogenesis. A total of 89 older adolescents from nine publications and ours were enrolled in SSR analysis. Forty-three out of 89 older adolescents (48.3%) had successful sperm retrieval, and no significant difference was noted between the mTESE and conventional TESE (cTESE).
Conclusions: Testicular SRR in older adolescents is not superior to those reported in adults in the literature. Reproductive counseling is mandatory, but aggressive FP might not be recommended in adolescents.