Full Text:   <1485>

Summary:  <1493>

CLC number: R697+.22

On-line Access: 2020-01-03

Received: 2019-07-12

Revision Accepted: 2019-09-04

Crosschecked: 2019-12-17

Cited: 0

Clicked: 2246

Citations:  Bibtex RefMan EndNote GB/T7714

-   Go to

Article info.
Open peer comments

Journal of Zhejiang University SCIENCE B 2020 Vol.21 No.1 P.87-92

http://doi.org/10.1631/jzus.B1900232


Modified stepwise mini-incision microdissection testicular sperm extraction: a useful technique for patients with a history of orchidopexy affected by non-obstructive azoospermia


Author(s):  Peng Li, Chen-Cheng Yao, Er-Lei Zhi, Yuan Xu, Zhong Wan, Ying-Chuan Jiang, Yu-Hua huang, Yue-Hua gong, Hui-Xing Chen, Ru-Hui Tian, Chao Yang, Liang-Yu Zhao, Zheng Li

Affiliation(s):  Department of Andrology, Center for Men’s Health, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China; more

Corresponding email(s):   lizhengboshi@sjtu.edu.cn

Key Words:  Non-obstructive azoospermia, Microdissection testicular sperm extraction, Orchidopexy, Cryptorchidism


Share this article to: More <<< Previous Article|

Peng Li, Chen-Cheng Yao, Er-Lei Zhi, Yuan Xu, Zhong Wan, Ying-Chuan Jiang, Yu-Hua huang, Yue-Hua gong, Hui-Xing Chen, Ru-Hui Tian, Chao Yang, Liang-Yu Zhao, Zheng Li. Modified stepwise mini-incision microdissection testicular sperm extraction: a useful technique for patients with a history of orchidopexy affected by non-obstructive azoospermia[J]. Journal of Zhejiang University Science B, 2020, 21(1): 87-92.

@article{title="Modified stepwise mini-incision microdissection testicular sperm extraction: a useful technique for patients with a history of orchidopexy affected by non-obstructive azoospermia",
author="Peng Li, Chen-Cheng Yao, Er-Lei Zhi, Yuan Xu, Zhong Wan, Ying-Chuan Jiang, Yu-Hua huang, Yue-Hua gong, Hui-Xing Chen, Ru-Hui Tian, Chao Yang, Liang-Yu Zhao, Zheng Li",
journal="Journal of Zhejiang University Science B",
volume="21",
number="1",
pages="87-92",
year="2020",
publisher="Zhejiang University Press & Springer",
doi="10.1631/jzus.B1900232"
}

%0 Journal Article
%T Modified stepwise mini-incision microdissection testicular sperm extraction: a useful technique for patients with a history of orchidopexy affected by non-obstructive azoospermia
%A Peng Li
%A Chen-Cheng Yao
%A Er-Lei Zhi
%A Yuan Xu
%A Zhong Wan
%A Ying-Chuan Jiang
%A Yu-Hua huang
%A Yue-Hua gong
%A Hui-Xing Chen
%A Ru-Hui Tian
%A Chao Yang
%A Liang-Yu Zhao
%A Zheng Li
%J Journal of Zhejiang University SCIENCE B
%V 21
%N 1
%P 87-92
%@ 1673-1581
%D 2020
%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.B1900232

TY - JOUR
T1 - Modified stepwise mini-incision microdissection testicular sperm extraction: a useful technique for patients with a history of orchidopexy affected by non-obstructive azoospermia
A1 - Peng Li
A1 - Chen-Cheng Yao
A1 - Er-Lei Zhi
A1 - Yuan Xu
A1 - Zhong Wan
A1 - Ying-Chuan Jiang
A1 - Yu-Hua huang
A1 - Yue-Hua gong
A1 - Hui-Xing Chen
A1 - Ru-Hui Tian
A1 - Chao Yang
A1 - Liang-Yu Zhao
A1 - Zheng Li
J0 - Journal of Zhejiang University Science B
VL - 21
IS - 1
SP - 87
EP - 92
%@ 1673-1581
Y1 - 2020
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.B1900232


Abstract: 
non-obstructive azoospermia (NOA), which is defined as the absence of spermatozoa in the ejaculate secondary to impaired spermatogenesis within the testis, may be caused by a variety of etiologies, including varicocele-induced testicular damage, cryptorchidism, prior testicular torsion, post-pubertal mumps orchitis, gonadotoxic effects from medications, genetic abnormalities, chemotherapy/radiation, and other unknown causes currently classified as idiopathic (Cocuzza et al., 2013). The microdissection testicular sperm extraction (micro-TESE) technique involves a meticulous microsurgical exploration of the testicular parenchyma to identify and selectively extract larger seminiferous tubules that carry a higher probability of complete spermatogenesis (Schlegel, 1999). The Cornell group evaluated the efficacy of micro-TESE in 152 NOA patients with an associated history of cryptorchidism. In their series, spermatozoa were successfully retrieved in 116/181 attempts (64%), and the resulting pregnancy rate was 50% with a delivery rate of 38% (Dabaja and Schlegel, 2013). Franco et al. (2016) described a stepwise micro-TESE approach in NOA patients, which was considered to reduce the cost, time, and effort associated with the surgery. Alrabeeah et al. (2016) further reported that a mini-incision micro-TESE, carried through a 1-cm equatorial testicular incision, can be useful for micro-TESE candidates, particularly in patients with cryptozoospermia. We conducted a retrospective study of 20 consecutive NOA patients with a history of orchidopexy from May 2015 to March 2017.

分步法小切口改良睾丸显微取精术在隐睾下降固定术后非梗阻性无精子症的临床应用研究

目的:探讨分步法小切口改良睾丸显微取精术在隐睾下降固定术后非梗阻性无精子症的有效性.
创新点:既往有隐睾下降固定术手术史的非梗阻性无精子症的患者睾丸局部粘连严重,所以睾丸显微取精术时睾丸暴露困难,因此手术难度明显增大.术者将常规睾丸显微取精术改良为分步法小切口睾丸显微取精术,术中无需完全游离暴露睾丸,仅通过小切口睾丸显微取精术就可使一半的患者成功获取精子.因此分步法小切口改良睾丸显微取精术可在不降低睾丸取精成功率的前提下缩短手术时间和减少手术创伤.
方法:收集2015年5月至2017年3月于上海交通大学附属第一人民医院泌尿中心男科接受睾丸显微取精术的20例既往有隐睾下降固定术手术史的非梗阻性无精子症,采用分步法小切口改良睾丸显微取精术获取睾丸精子.分步法小切口改良睾丸显微取精术具体步骤为:第一步,小切口睾丸取精术;第二步,将小切口延长为标准切口,行标准睾丸显微取精术;第三步,对侧睾丸标准睾丸显微取精术.
结论:小切口睾丸显微取精术可快速有效获取睾丸内表浅位置饱满的生精小管,标准的睾丸显微取精术可作为小切口睾丸显微取精术失败时的补救措施.分步法小切口睾丸显微取精术可降低睾丸损伤前提下,快速有效地获取睾丸精子.这种手术方式特别适用于睾丸内存在表浅饱满生精小管的非梗阻性无精子症,如隐睾下降固定术后的非梗阻性无精子症.

关键词:非梗阻性无精子症;隐睾;睾丸显微取精术;睾丸下降固定术;精子获取

Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article

Reference

[1]Alrabeeah K, Witmer J, Ruiz S, et al., 2016. Mini-incision microdissection testicular sperm extraction: a useful technique for men with cryptozoospermia. Andrology, 4(2):284-289.

[2]Bernie AM, Ramasamy R, Schlegel PN, 2013. Predictive factors of successful microdissection testicular sperm extraction. Basic Clin Androl, 23:5.

[3]Cocuzza M, Alvarenga C, Pagani R, 2013. The epidemiology and etiology of azoospermia. Clinics (Sao Paulo), 68(S1):15-26.

[4]Dabaja AA, Schlegel PN, 2013. Microdissection testicular sperm extraction: an update. Asian J Androl, 15(1):35-39.

[5]Docimo SG, 1995. The results of surgical therapy for cryptorchidism: a literature review and analysis. J Urol, 154(3):1148-1152.

[6]Franco G, Scarselli F, Casciani V, et al., 2016. A novel stepwise micro-TESE approach in non obstructive azoospermia. BMC Urol, 16:20.

[7]Grasso M, Buonaguidi A, Lania C, et al., 1991. Postpubertal cryptorchidism: review and evaluation of the fertility. Eur Urol, 20(2):126-128.

[8]Hadziselimovic F, Herzog B, 2001. The importance of both an early orchidopexy and germ cell maturation for fertility. Lancet, 358(9288):1156-1157.

[9]Haimov-Kochman R, Prus D, Farchat M, et al., 2010. Reproductive outcome of men with azoospermia due to cryptorchidism using assisted techniques. Int J Androl, 33(1):e139-e143.

[10]Lin YM, Hsu CC, Wu MH, et al., 2001. Successful testicular sperm extraction and paternity in an azoospermic man after bilateral postpubertal orchiopexy. Urology, 57(2):365.

[11]Liu F, Zou SS, Zhu Y, et al., 2017. A novel micro-straw for cryopreservation of small number of human spermatozoon. Asian J Androl, 19(3):326-329.

[12]Ma M, Ping P, Wang JH, et al., 2012. Three-step sperm retrieval for 73 non-obstructive azoospermia patients. Nat J Androl, 18(7):606-610 (in Chinese).

[13]Negri L, Albani E, DiRocco M, et al., 2003. Testicular sperm extraction in azoospermic men submitted to bilateral orchidopexy. Hum Reprod, 18(12):2534-2539.

[14]Ohlander S, Hotaling J, Kirshenbaum E, et al., 2014. Impact of fresh versus cryopreserved testicular sperm upon intracytoplasmic sperm injection pregnancy outcomes in men with azoospermia due to spermatogenic dysfunction: a meta-analysis. Fertil Steril, 101(2):344-349.

[15]Raman JD, Schlegel PN, 2003. Testicular sperm extraction with intracytoplasmic sperm injection is successful for the treatment of nonobstructive azoospermia associated with cryptorchidism. J Urol, 170(4):1287-1290.

[16]Schachter-Safrai N, Karavani G, Levitas E, et al., 2017. Does cryopreservation of sperm affect fertilization in nonobstructive azoospermia or cryptozoospermia? Fertil Steril, 107(5):1148-1152.

[17]Schlegel PN, 1999. Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision. Hum Reprod, 14(1):131-135.

[18]Serrano T, Chevrier C, Multigner L, et al., 2013. International geographic correlation study of the prevalence of disorders of male reproductive health. Hum Reprod, 28(7):1974-1986.

[19]Sun J, Chen W, Zhou L, et al., 2017. Successful delivery derived from cryopreserved rare human spermatozoa with novel cryopiece. Andrology, 5(4):832-837.

[20]Vernaeve V, Krikilion A, Verheyen G, et al., 2004. Outcome of testicular sperm recovery and ICSI in patients with non-obstructive azoospermia with a history of orchidopexy. Hum Reprod, 19(10):2307-2312.

[21]Wood HM, Elder JS, 2009. Cryptorchidism and testicular cancer: separating fact from fiction. J Urol, 181(2):452-461.

Open peer comments: Debate/Discuss/Question/Opinion

<1>

Please provide your name, email address and a comment





Journal of Zhejiang University-SCIENCE, 38 Zheda Road, Hangzhou 310027, China
Tel: +86-571-87952783; E-mail: cjzhang@zju.edu.cn
Copyright © 2000 - 2023 Journal of Zhejiang University-SCIENCE