Assessment of the use of contrast enhanced ultrasound in guiding microdissection testicular sperm extraction in nonobstructive azoospermia

Abstract

BackgroundThe aim of this study is to assess the value of contrast-enhanced ultrasound (CEUS) as a new non-invasive approach to locate the testicular area in which spermatogenesis is most likely to be found in non-obstructive azoospermic testes and to evaluate the accuracy of CEUS as a predictor of successful sperm retrieval.MethodsCEUS was performed in 120 nonobstructive azoospermia (NOA) patients. Microdissection testicular sperm extraction (M-TESE) was performed on the best and poorest perfusion areas selected by CEUS and on conventional areas.ResultsIn the 187 testicles that underwent M-TESE, the sperm retrieval rates (SRRs) in the best perfusion area and poorest perfusion area over the maximal longitudinal section and conventional area were 63.1, 34.7 and 47.1%. According to receiver operating characteristic (ROC) analysis, the arrival times (AT) ≤27 s, time-to-peak intensity (TTP) ≤45 s, and peak intensity (PI) ≥11 dB were the best predictors of positive sperm retrieval. The location of the best perfusion area was able to guide M-TESE to improve the success rates.ConclusionsTesticle CEUS is suggested to be performed in all patients with NOA. If AT≤27 s, TTP ≤ 45 s or PI≥11 dB are found in the best perfusion area, M-TESE is strongly recommended.

Novel methods to enhance surgical sperm retrieval: a systematic review

“…Conversely, a 2018 study that utilised CEUS in 120 men with NOA and subsequent micro-TESE, demonstrated improved success rates for micro-TESE potentially due to CEUS’s ability to locate the best perfusion areas. This work suggests that CEUS can highlight microvascular distribution in testicles, aid in locating areas of best perfusion over the maximal longitudinal section, and improve success rates [ 36 ]. Lastly, work by Herwig et al [ 37 ] with patients with azoospermia undergoing TESE biopsy for retrieval of sperm showed high sperm quality in areas of high tissue perfusion.…”

“…Furthermore, the images that are available in real time are taken using a low-magnification microscope and the details of these images are not clear, the pictures are very ‘noisy’ [ 39 ]. Overall, while some barriers exist to the use of AI and deep learning in reproductive medicine, overcoming these barriers will allow rapid predicting capabilities, identification mechanisms, and analysis of sperm integrity done in real time, without the need of samples being stained for identification purposes ( Table 2 ) [ 4 , 7 , 10 , 11 , 13 , 14 , 17–24 , 28 , 31 , 33 , 36–39 , 41 , 43 ].…”

“…Elimination of eyepieces allows for better surgical posture [21] Simple to use and easy to transport May allow for shorter surgery times [21] Wider FOV and longer DOF eliminates need for frequent repositioning [22] 3D viewing monitors provides optimal teaching/ demonstration environment [23] Cost Surgical assistants have rotated surgical view, which can lead to confusion during operation [24] Ultrasonography Fast, easy, portable [28] Widely available [28] Ability to locate areas of high perfusion [33] Help rule out areas of absent spermatogenesis [31] Improve success rates of sperm retrievals [36,37] Operator dependent [38] Requires training and experience [38] Difficulty with resolving microvasculature of the testicle [31] Artificial Intelligence Automated assessment of extracted sperm [37,38,44] Real-time analysis of sperm [37] Ability to work with unstained images [37] High accuracy [37] Ability to predict outcomes prior to extraction [41] Avoid operator dependence [43] Training phase of AI can be limited by the number of sperm images available [39] Limited by quality of microscopy images [39] Technology is not widely available Requires collaboration between computer scientists and clinicians FOV: field of view; DOF, depth of field.…”

Contrast-Enhanced Ultrasound Evaluation of Mifepristone for Treatment of Low-Risk Cesarean Scar Pregnancy

“…The ROIs were located at the embryo decidua basalis. Related parameters obtained through the time intensity curve (TIC) included arrival time (AT, the time from injection of the agent to the point when the first contrast bubbles appeared in the gestational sac), peak intensity (PI, the maximal intensity of the TIC), and area under the curve around the gestational sac (AUC, the area under the TIC) [ 17 ].…”

Use of contrast enhanced ultrasound in testicular diseases: A comprehensive review

“…86 Since then, only two recent studies have focused on determining the usefulness of CEUS in infertility, by investigating whether it could be used to predict the success rate of testicular sperm retrieval techniques in infertile men. 37,38 Zhang et al evaluated whether CEUS could be considered as a noninvasive approach for detecting the testicular area where spermatogenesis is most likely to be found in nonobstructive azoospermic testes. Among the 187 testes that underwent microdissection TESE, the sperm retrieval rates of the best perfusion area over the maximal longitudinal section were higher than those with the poorest perfusion area and conventional area where TESE is usually performed (63.1% vs. 34.7% and 47.1% respectively, p < 0.05).…”