Efficacy of stepwise mini-incision microdissection testicular sperm extraction for nonobstructive azoospermia with varied etiologies  

作　　者：Yu-Xiang Zhang Chen-Cheng Yao Yu-Hua Huang Peng Li Er-Lei Zhi Zi-Jue Zhu Jian-Xiong Zhang Fu-Jun Zhao Zheng Li Ru-Hui Tian 

机构地区：[1]Department of Andrology,The Center for Men's Health,Urologic Medical Center,Shanghai Key Laboratory of Reproductive Medicine,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200080,China

出　　处：《Asian Journal of Andrology》2023年第5期621-626,共6页亚洲男性学杂志（英文版）

基　　金：supported by the National Natural Science Foundation of China(No.82171590,82171597,and 82001530);Clinical Research Innovation Plan of Shanghai General Hospital(KD007-ly01,and CTCCR-C04)。

摘　　要：Stepwise mini-incision microdissection testicular sperm extraction(mTESE)is a procedure that attempts to minimize testicular damage.However,the mini-incision approach may vary in patients with different etiologies.Here,we performed a retrospective analysis of 665 men with nonobstructive azoospermia(NOA)who underwent stepwise mini-incision mTESE(Group 1)and 365 men who underwent standard mTESE(Group 2).The results showed that the operation time(mean±standard deviation)for patients with successful sperm retrieval in Group1(64.0±26.6min)was significantly shorter than that in Group2(80.2±31.3min),with P<0.001.The total sperm retrieval rate(SRR)was 23.1%in our study,and there was no significant difference between Group 1 and Group 2(P>0.05),even when the etiologies of NOA were taken into consideration.The results of consecutive multivariate logistic regression analysis(odds ratio[0R]:0.57;95%confidence interval[Cl]:0.38-0.87;P=0.009)and receiver operating characteristic(ROC)analysis(area under the ROC curve[AUC]=O.628)showed that preoperative anti-Mullerian hormone(AMH)level in idiopathic NOA patients was a potential predictor for surgical outcomes after initial three small incisions made in the equatorial region without sperm examined under an operating microscope(Steps 2-4).In conclusion,stepwise mini-incision mTESE is a useful technique for NOA patients,with comparable SRR,less surgical invasiveness,and shorter operation time compared with the standard approach.Low AMH levels may predict successful sperm retrieval in idiopathic patients even after a failed initial mini-incision procedure.

关 键 词：etiology male infertility nonobstructive azoospermia standard mTESE stepwise mini-incision mTESE 

分 类 号：R69[医药卫生—泌尿科学]