| Objective:Through the evaluation of preoperative and intraoperative indicators in patients with non-obstructive azoospermia(NOA),we aimtohave found several factorsand new methods that have predictive value for microdissection testicular sperm extraction(Micro-TESE).These would provide a theoretical reference for clinicians to choose a more reasonable treatment plan to minimize the damage of patients.Methods:Retrospective analysis of 189 patients with NOA who underwent Micro-TESE at the 1st Hospital of Jilin University from March 2016 to January 2019.Through various clinical indicators of NOA patients,etiology,pathology and the evaluation of intraoperative testicular seminiferous tubules,the success rate of micro-TESE and the new research methodwere predicted.Meanwhile,it would guide surgical plan.Preoperative factors included etiology,age,testicular volume,reproductive hormone and pathological diagnosis.Intraoperative evaluation included the assessment of the homogeneity of the seminiferous tubules and the diameter of the seminiferous tubules.New research methods include further classification and screening of genetic causes,and further classification of pathology.Conventionalclinical factors was classified separately,(1)age:?30 group and >30 group;(2)Testicular volume:?5ml group,5-10 ml group and ?10ml group.(3)follicle-stimulating hormone(FSH):?12.4m IU/l,12.4-24.8m IU/l group and ?24.8m IU/l group;(4)luteinizing hormone(LH):?8.6m IU/l group,8.6-17.2m IU/l and ?17.2m IU/l group;(5)testosterone(T):?9.9nmol/l group and >9.9nmol/l group;(6)etiology: Klinefelter syndrome group,Y chromosome microdeletion group,cryptorchidism group,orchitis group,idiopathic NOA group;(7)pathological type: Sertoli cell-noly syndrome(SCOS),maturation arrest(MA),hypospermatogenesis (HS),hyalinization.New research methods:(1)Increase the number of cells in the karyotype examination and analyze the correlation between a small proportion of mosaic KS and sperm retrieval rate.(2)Increases STS in Y chromosome microdeletion examination by the high-throughput sequencing,identify the deletion areas and new deletion STS.(3)Screening for gene mutation sites by high-throughput sequencing.(4)Uniformity of pathological classification: further classified into 8 categories according to whether only a single pathological tissue type is included: complete SCOS,mixed SCOS,complete MA,mixed MA,complete HS,mixed HS,complete hyalinization,mixed hyalinization;(5)Intraoperativeevaluation:(1)intraoperative seminiferous tubule homogeneity: homogeneous seminiferous tubule,heterogeneous tubule;(2)Diameter of seminiferous tubules: ?100?m group and <100?m group.tor combination analysis,(main evaluation index is the sperm retrieval rate).Results:1.Total successful sperm retrieval rate is 32.3%(61 in 189 cases)2.ROC curve shows: pathology,testicular volume,and T have predictive value.3.Analysis of clinical indicators(1)Characteristics of clinical indicators of the successful sperm retrieval: T level(P=0.038)and testicular volume(P=0.013)were significantly lower than those of the no sperm retrieval group.(2)Testicular volume: The successful sperm retrieval rate in testicular volume ?5ml group was significantly higher than in the 5-10 ml group(P<0.001)and ?10ml group(P=0.032).(3).T level: T?9.9nmol/l group was significantly higher than T>9.9nmol/l,P=0.0(4)Age,FSH,and LH had no effect on the rate of successful sperm retrieval.And there was no statistical difference in other groups.4.Etiology analysis(1)Successful sperm retrieval rate: The rate in idiopathic NOA group was significantly lower than that of Klinefelter syndrome(P=0.001)and cryptorchidism(P<0.001).(2)There was no statistical difference between the successful sperm retrieval group and no sperm-retrieval group.(3)KS: Increase the number of karyotypes to detect a small proportion of mosaic KS,and the higher the mosaic KS ratio,the higher the SSR.(4)Y-chromosome microdeletion: The new deletion STS,the specific deletion region and size can be detectedby the high-throughput sequencing method,which is more advantageous than conventional PCR methods.However,there is no difference in deletion sites among the similar patients enrolled.(5)Gene screening by high-throughput sequencing:A total of 32 cases were detected and 5 cases were positive(15.6%).The mutated genes found were TEX11,KISS1 R,HSF2,NR5A1,and DNAH11,respectively.5.Analysis of etiology combined with clinical indicators(1)In idiopathic NOA,the successful sperm retrieval rate of the patients with testicular volume ? 5 ml and FSH ? 24.8 m IU/ml group were significantly higher than testicular volume 5-10 ml and FSH 12.4-24.8 m IU/ml group(P=0.026).(2)In idiopathic NOA,the patients with testicular volume ? 5ml(no matter the LH level)group was significantly higher sperm retrieval rate than testicular volume 5-10 ml group with LH 8.6-17.2m IU/ml group(P<0.05).(3)In idiopathic NOA patients with testicular volume?5ml and normal T level,successful sperm retrieval rate is significantly higher than testicular volume of 5-10 ml group with low T level(P=0.006),as well as normal group(P=0.01).The testicular volume?10 ml with low T level group had significantly higher successful sperm retrieval rate than testicular volume 5-10 ml with low T level group(P=0.041).6.Histopathological analysis(1)The successful sperm retrieval rate of the SCOS group was significantly lower than that of the HS group(P<0.001)and the transparent sample group(P=0.001).The sperm concentration of the MA group was significantly lower than that of the HS group(P=0.002).(2)The testicular volume of the SCOSinthesuccessful sperm retrieval group was significantly lower than that of in the no sperm retrieval group(P=0.002).There were no statistical differences in other pathological types.7.Pathological classification combined with clinical indicators analysis(1)The successful sperm retrieval rate of SCOS combined with testis ? 5ml group was significantly higher than testicular volume=5-10 ml group(P=0.043)and testis ?10ml group(P=0.016).(2)The LH level of hyaline degeneration group was 8.6-17.2 m IU/ml,which was significantly higher sperm retrieval rate than that of LH?17.2 m IU/ml group(P=0.041)in successful sperm retrieval.(3)The successful sperm retrieval rate of the low T level in MA(P=0.026)and HS(P=0.004)groups was significantly higher than normal T level group.8.Uniformity analysis of pathology(1)Successful sperm retrieval rate: in mixed pathology group,the successful sperm retrieval rate was significantly higher than that of single-type pathology(P<0.001).And the rate of successful sperm retrieval in mixed pathology SCOS group was significantly higher than single-type pathology SCOS group(P=0.019).(2)The T level in the patients of the single-type pathological tissue was significantly lower in the successful sperm retrieval group than no sperm retrieval group(P=0.024).There was no statistical difference between the two mixed pathology groups.9.Intraoperative evaluation(1)Successful sperm retrieval rate: the rate in heterogeneous tubule group was significantly higher than thehomogenous tubule group(P<0.001).In heterogeneous tubule group,when no sperm retrieval in one side,the chance of getting sperm in the contralateral testis was significantly higher than homogenous tubule group.(P<0.001).(2)There was no statistical difference between successful sperm retrieval group and no sperm retrieval group.10.Etiology/Pathological combined with intraoperative assessment(1)In the group of idiopathic NOA(P<0.001)and Klinefelter syndrome(P=0.007),the successful sperm retrieval rate of the heterogeneous tubule group was significantly higher than that of the homogenous tubule group.There was no statistical difference in other groups.(2)The idiopathic NOA: when one testis was no sperm retrieval,the successful sperm retrieval rate of the contralateral testis inheterogeneous tubule group was significantly higher than that inhomogenous group(P=0.007).(3)In SCOS(P=0.003)and hyaline degeneration(P=0.002)group,the precision of the sperm retrieval rate in heterogeneous tubule group was significantly higher than that of homogeneous group.(4)In the SCOS group,the precision of the rate of successful sperm retrieval in seminiferous tubules diameter?100?m was significantly lower than that of the<100 ?m group(P<0.001).31 cases of seminiferous tubules diameter?100?m contralateral testicular surgery,all not sperm found.Conclusions:1.Testicular volume ?5ml or T level ?9.9nmol/l have low predictive value for the outcome of micro-TESE.2.In idiopathic NOA patients combed testicular volume and hormone can improve prediction accuracy;increasing the number of cells in the karyotype examination in patients with Klinefelter syndrome can detect a small proportion of 46,XY mosaic,and improve the accuracy of prediction;disease-causing genes screening can identify unknown causes and guide the surgical options.3.Among the testicular pathological types,the successful sperm retrieval rate in SCOS group is significantly lower than that of the HS group;the combination of pathological with different clinical indicators and unity typing of pathological tissue further improves the accuracy of the accuracy rate prediction.4.Introperationly,when idiopathic NOA or SCOS group combined with the homogenous tubule group or SCOS group combined with tubules ?100?m,the SRR was extremely low on the other side when one testis was no sperm retrieval.After the patient's informed consent,superficial surgery or even cancellation of the testicle on the other side was feasible... |
PDF Full Text Request