Abstract：
BACKGROUND: There has been no systematic review and meta-analysis to analyze and summarize the predictive factors of successful sperm extraction in salvage microdissection testicular sperm extraction.
OBJECTIVE: We aimed to investigate the factors predicting the result of salvage microdissection testicular sperm extraction in patients with non-obstructive azoospermia who failed the initial microdissection testicular sperm extraction or conventional testicular sperm extraction.
METHODS: We conducted a systematic literature search in PubMed, Web of Science, EMBASE, and the Cochrane Library for literature that described the characteristics of patients with non-obstructive azoospermia who underwent salvage microdissection testicular sperm extraction after failing the initial microdissection testicular sperm extraction or conventional testicular sperm extraction published prior to June 2022.
RESULTS: This meta-analysis included four retrospective studies with 332 patients with non-obstructive azoospermia who underwent a failed initial microdissection testicular sperm extraction and three retrospective studies with 177 non-obstructive azoospermia patients who underwent a failed conventional testicular sperm extraction. The results were as follows: among non-obstructive azoospermia patients whose first surgery was microdissection testicular sperm extraction, younger patients (standard mean difference: -0.28, 95% confidence interval [CI]: -0.55 to -0.01) and those with smaller bilateral testicular volume (standard mean difference: -0.55, 95% CI: -0.95 to -0.15), lower levels of follicle-stimulating hormone (standard mean difference: -0.86, 95% CI: -1.18 to -0.54) and luteinizing hormone (standard mean difference: -0.68, 95% CI: -1.16 to -0.19), and whose testicular histological type was hypospermatogenesis (odds ratio: 3.52, 95% CI: 1.30-9.53) were more likely to retrieve spermatozoa successfully, while patients with Sertoli-cell-only syndrome (odds ratio: 0.41, 95% CI: 0.24-0.73) were more likely to fail again in salvage microdissection testicular sperm extraction. Additionally, in patients who underwent salvage microdissection testicular sperm extraction after a failed initial conventional testicular sperm extraction, those with testicular histological type of hypospermatogenesis (odds ratio: 30.35, 95% CI: 8.27-111.34) were more likely to be successful, while those with maturation arrest (odds ratio: 0.39, 95% CI: 0.18-0.83) rarely benefited.
CONCLUSIONS: We found that age, testicular volume, follicle-stimulating hormone, luteinizing hormone, hypospermatogenesis, Sertoli-cell-only syndrome, and maturation arrest were valuable predictors of salvage microdissection testicular sperm extraction, which will assist andrologists in clinical decision-making and minimize unnecessary injury to patients.
OBJECTIVE: We aimed to investigate the factors predicting the result of salvage microdissection testicular sperm extraction in patients with non-obstructive azoospermia who failed the initial microdissection testicular sperm extraction or conventional testicular sperm extraction.
METHODS: We conducted a systematic literature search in PubMed, Web of Science, EMBASE, and the Cochrane Library for literature that described the characteristics of patients with non-obstructive azoospermia who underwent salvage microdissection testicular sperm extraction after failing the initial microdissection testicular sperm extraction or conventional testicular sperm extraction published prior to June 2022.
RESULTS: This meta-analysis included four retrospective studies with 332 patients with non-obstructive azoospermia who underwent a failed initial microdissection testicular sperm extraction and three retrospective studies with 177 non-obstructive azoospermia patients who underwent a failed conventional testicular sperm extraction. The results were as follows: among non-obstructive azoospermia patients whose first surgery was microdissection testicular sperm extraction, younger patients (standard mean difference: -0.28, 95% confidence interval [CI]: -0.55 to -0.01) and those with smaller bilateral testicular volume (standard mean difference: -0.55, 95% CI: -0.95 to -0.15), lower levels of follicle-stimulating hormone (standard mean difference: -0.86, 95% CI: -1.18 to -0.54) and luteinizing hormone (standard mean difference: -0.68, 95% CI: -1.16 to -0.19), and whose testicular histological type was hypospermatogenesis (odds ratio: 3.52, 95% CI: 1.30-9.53) were more likely to retrieve spermatozoa successfully, while patients with Sertoli-cell-only syndrome (odds ratio: 0.41, 95% CI: 0.24-0.73) were more likely to fail again in salvage microdissection testicular sperm extraction. Additionally, in patients who underwent salvage microdissection testicular sperm extraction after a failed initial conventional testicular sperm extraction, those with testicular histological type of hypospermatogenesis (odds ratio: 30.35, 95% CI: 8.27-111.34) were more likely to be successful, while those with maturation arrest (odds ratio: 0.39, 95% CI: 0.18-0.83) rarely benefited.
CONCLUSIONS: We found that age, testicular volume, follicle-stimulating hormone, luteinizing hormone, hypospermatogenesis, Sertoli-cell-only syndrome, and maturation arrest were valuable predictors of salvage microdissection testicular sperm extraction, which will assist andrologists in clinical decision-making and minimize unnecessary injury to patients.
摘要：
背景：目前还没有系统评价和荟萃分析来分析和总结挽救性微解剖睾丸精子提取（mTESE）中精子提取成功的预测因素。
目的：我们旨在研究预测初次mTESE或常规睾丸精子提取（cTESE）失败的NOA患者mTESE挽救结果的因素。
方法：我们在PubMed，WebofScience,EMBASE,和Cochrane图书馆提供的文献描述了在2022年6月之前发表的初始mTESE或cTESE未通过后接受抢救mTESE的NOA患者的特征。
结果：本荟萃分析包括4项回顾性研究，对332例初次mTESE失败的NOA患者和3项回顾性研究，对177例cTESE失败的NOA患者。结果如下：在首次手术为mTESE的NOA患者中，年轻患者（SMD：-0.28，95％CI：-0.55至-0.01）和双侧睾丸体积（TV）较小的患者（SMD：-0.55，95％CI：-0.95至-0.15），较低水平的FSH（SMD：-0.86，95%CI：-1.18至-0.54）和LH（SMD：-0.68，95%CI：-1.16至-0.19），睾丸组织学类型为精子发生障碍（HS）（OR：3.52，95％CI：1.30至9.53）更有可能成功回收精子。而仅支持细胞综合征（SCOS）（OR：0.41，95％CI：0.24至0.73）的患者在挽救性mTESE中再次失败的可能性更大。此外,在初次cTESE失败后接受抢救mTESE的患者中，那些睾丸组织学类型的精子发生不足（HS）（OR：30.35，95％CI：8.27至111.34）更有可能成功，而那些成熟停滞（MA）（OR：0.39，95％CI：0.18至0.83）的患者很少受益。
结论：我们发现年龄，电视,FSH,LH,HS,SCOS和MA是救助mTESE的有价值的预测因子，这将有助于男科医生的临床决策，并最大限度地减少对患者不必要的伤害。本文受版权保护。保留所有权利。
目的：我们旨在研究预测初次mTESE或常规睾丸精子提取（cTESE）失败的NOA患者mTESE挽救结果的因素。
方法：我们在PubMed，WebofScience,EMBASE,和Cochrane图书馆提供的文献描述了在2022年6月之前发表的初始mTESE或cTESE未通过后接受抢救mTESE的NOA患者的特征。
结果：本荟萃分析包括4项回顾性研究，对332例初次mTESE失败的NOA患者和3项回顾性研究，对177例cTESE失败的NOA患者。结果如下：在首次手术为mTESE的NOA患者中，年轻患者（SMD：-0.28，95％CI：-0.55至-0.01）和双侧睾丸体积（TV）较小的患者（SMD：-0.55，95％CI：-0.95至-0.15），较低水平的FSH（SMD：-0.86，95%CI：-1.18至-0.54）和LH（SMD：-0.68，95%CI：-1.16至-0.19），睾丸组织学类型为精子发生障碍（HS）（OR：3.52，95％CI：1.30至9.53）更有可能成功回收精子。而仅支持细胞综合征（SCOS）（OR：0.41，95％CI：0.24至0.73）的患者在挽救性mTESE中再次失败的可能性更大。此外,在初次cTESE失败后接受抢救mTESE的患者中，那些睾丸组织学类型的精子发生不足（HS）（OR：30.35，95％CI：8.27至111.34）更有可能成功，而那些成熟停滞（MA）（OR：0.39，95％CI：0.18至0.83）的患者很少受益。
结论：我们发现年龄，电视,FSH,LH,HS,SCOS和MA是救助mTESE的有价值的预测因子，这将有助于男科医生的临床决策，并最大限度地减少对患者不必要的伤害。本文受版权保护。保留所有权利。
