睪丸切片是否會降低非阻塞性無精症病患成功取精的機會？
許自翔1、黃奕燊1,2,3、顧明軒1、陳威任1,2,3、黃逸修1,2,3、黃志賢1,2,3
1臺北榮民總醫院 泌尿部
2國立陽明大學 醫學院 泌尿學科；3書田泌尿科學研究中心
Dose testicular needle biopsy decrease the sperm retrieval rate in patients with non-obstructive azoospermia?
Tzu-Hsiang Hsu1, I-Shen Huang1,2,3, Ming-Hsuan Ku1,
Wei-Jen Chen1,2,3, Eric Yi-Hsiu Huang1,2,3, William J. Huang1,2,3
1Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan
2Department of Urology, School of Medicine, and 3Shu-Tien Urological Science Research Center, National Yang-Ming University
Purpose: Testicular biopsy provide diagnostic value for azoospermic men. It could be performed percutaneously with local anesthesia in OPD setting but testicular damage following testicular sperm retrieval was reported in animal model. This study aimed to analyze if testicular biopsy decreases the sperm retrieval rate (SRR).
Materials and Methods: We retrospectively reviewed the database in patients who visited our urology clinic for male infertility and was diagnosed as non-obstructive azoospermia (NOA) between October 2009 and December 2014. All patients with NOA who had undergone micro-TESE surgery were enrolled. History, physical examination findings, endocrine profiles, testicular histology and sperm retrieval rates. were analyzed in this study.
Results: In total, 200 patents with a mean age of 35.1±4.5 years were enrolled, with serum follicle stimulating hormone (FSH) levels of 25.1±15.5 mIU/ml, luteinizing hormone (LH) level of 11.4±9.8 mIU/ml and testosterone of 3.4±2.0 ng/ml. . Among them, 112 (56%) had received prior testicular biopsy.
In an unmatched analysis, the SRR were 32% in patient without testicular biopsy and 29% in patients who received testicular biopsy before micro-TESE surgery. However, no significant difference was found by chi-square test. The SRR of hypospermatogenesis, early maturation arrest (EMA), late maturation arrest (LMA) and Sertoli cell-only syndrome were 93.3%, 13.3%, 66.7% and 18.1%, respectively. Following propensity score matching by testicular volume, there was still no significant difference in SRR.
Conclusions: The percutaneous testicular needle biopsy is a safe and feasible procedure for patients with NOA. The sperm retrieval rate would not be compromised by testicular biopsy.
References:
- Schoor, Richard A., et al. "The role of testicular biopsy in the modern management of male infertility." The Journal of urology 167.1 (2002): 197-200.
- Chiba, Koji, Noritoshi Enatsu, and Masato Fujisawa. "Management of non-obstructive azoospermia." Reproductive medicine and biology 15.3 (2016): 165-173.
- Fedder, Jens, et al. "Testicular damage following testicular sperm retrieval: A Ram Model Study." BioMed research international 2017 (2017).
- Mao, J. M., et al. "Effect of testicular puncture biopsy on the success rate of microdissection testicular sperm extraction for idiopathic non-obstructive azoospermia." Beijing da xue xue bao. Yi xue ban= Journal of Peking University. Health sciences 50.4 (2018): 613-616.