目的:探讨非梗阻性无精子症(NOA)性腺功能低下男性睾丸精子显微剥离术(micro-TESE)成功的影响因素。
方法:队列研究。
方法:大学附属男性生殖健康中心。
方法:在2014年至2021年期间,有616名患有性腺功能减退(总睾酮[T]水平<350ng/dL)的连续NOA患者接受微TESE。所有患者均无精子提取(SR)史。
方法:23-55岁的患者接受了全面的临床,实验室,和NOA的组织病理学诊断评估,并根据SR前激素刺激进一步分为两个队列。
方法:多变量逻辑回归分析探讨了患者变量与显微TESE成功之间的关联,定义为在提取的标本中存在活精子。计算调整后的比值比(aOR)和95%置信区间(CI)以评估SR成功与相关预测因子之间的关系。比较接受或不接受激素刺激的患者的SR率,和逻辑回归分析评估了基线FSH水平的影响(即,促性腺激素与促性腺激素类)对SR成功。
结果:总体微TESE成功率为56.6%。基线FSH水平(aOR0.97,95%CI0.94-0.99,p=0.04),前SR激素刺激(aOR2.54,1.64-3.93,p=0.0002),临床精索静脉曲张的存在(aOR0.05,0.01-0.51,p=0.04),既往有精索静脉曲张切除术史(aOR2.55,1.26-5.16,p=0.01),和睾丸组织病理学(p<0.01)是SR成功的独立预测因子。在激素预处理的患者中,微TESE前T水平和DeltaT(T水平从基线的绝对增加)与SR成功相关(p<0.05)。418.5ng/dL(AUC:0.78)的微TEST前水平和258ng/dL(AUC:0.76)的DeltaT区分具有阳性和阴性SR结果的患者。亚组分析显示,前SR激素刺激对促性腺激素正常的患者比对促性腺激素高的患者产生更大的益处。
结论:本研究强调了临床因素与NOA性腺功能减退男性的微TESE成功之间的关联。虽然因果关系不成立,我们的研究结果表明,这些患者可能受益于前SR干预,特别是激素刺激和精索静脉曲张修复。
OBJECTIVE: To explore factors influencing microdissection testicular sperm extraction (micro-TESE) success in hypogonadal men with nonobstructive azoospermia (NOA).
METHODS: Cohort study.
METHODS: University-affiliated male reproductive health center.
METHODS: 616 consecutive NOA patients with hypogonadism (total testosterone [T] levels <350 ng/dL) undergoing micro-TESE between 2014 and 2021. All patients had no prior sperm retrieval (SR) history.
METHODS: Patients aged 23-55 underwent comprehensive clinical, laboratory, and histopathological diagnostic evaluation for NOA and were further categorized into two cohorts based on pre-SR hormonal stimulation.
METHODS: Multivariable logistic regression analysis explored the associations between patient variables and micro-TESE success, defined as the presence of viable spermatozoa in extracted specimens. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were computed to assess the relationship between SR success and relevant predictors. SR rates were compared between patients receiving or not hormonal stimulation, and logistic regression analysis evaluated the effect of baseline FSH levels (i.e., normogonadotropic vs. hypergonadotropic classes) on SR success.
RESULTS: The overall micro-TESE success rate was 56.6%. Baseline FSH levels (aOR 0.97, 95% CI 0.94-0.99, p=0.04), pre-SR hormonal stimulation (aOR 2.54, 1.64-3.93, p=0.0002), presence of clinical
varicocele (aOR 0.05, 0.01-0.51, p=0.04), history of previous varicocelectomy (aOR 2.55, 1.26-5.16, p=0.01), and testicular histopathology (p<0.01) were independent predictors of SR success. Among hormone-pretreated patients, pre-micro-TESE T levels and Delta T (absolute increase in T levels from baseline) were associated with SR success (p<0.05). A pre-micro-TESE T level of 418.5 ng/dL (AUC: 0.78) and a Delta T of 258 ng/dL (AUC: 0.76) distinguished patients with positive and negative SR outcomes. Subgroup analysis showed that pre-SR hormonal stimulation yielded a greater benefit for normogonadotropic patients than for those who were hypergonadotropic.
CONCLUSIONS: This study underscores the association between clinical factors and micro-TESE success in hypogonadal men with NOA. While causality is not established, our findings suggest that these patients may benefit from pre-SR interventions, particularly hormonal stimulation and
varicocele repair.