Re: predictors of surgical sperm retrieval in non-obstructive azoospermia: summary of current literature

Colpi, Giovanni M.; Caroppo, Ettore

doi:10.1007/s11255-020-02535-6

Cited by 3 publications

(5 citation statements)

References 17 publications

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“…We were unable to find pre‐surgical predictors of salvage mTESE outcome, in agreement with what has been previously demonstrated in this field (reviewed in Colpi and Caroppo 22 ). One previous study 15 proposed that testosterone and testis histology could predict the outcome of salvage mTESE, but its results were based upon an overfitted model with 12 candidate predictors run on a sample of only 52 patients.…”

Section: Discussionsupporting

confidence: 90%

“…20 We optimized the testosterone levels only in the patients with hypogonadism before surgery, since a pooled estimation of previous results demonstrated that patients with normal testosterone levels had a significantly higher chance of SSR compared to those with subnormal levels (OR 1.63, 95% CI 1.08-2.45; p = 0.02). 21 We were unable to find pre-surgical predictors of salvage mTESE outcome, in agreement with what has been previously demonstrated in this field (reviewed in Colpi and Caroppo 22 ). One previous study 15 proposed that testosterone and testis histology could predict the outcome of salvage mTESE, but its results were based upon an overfitted model with 12 candidate predictors run on a sample of only 52 patients.…”

Section: Discussionsupporting

confidence: 88%

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Intrasurgical parameters associated with successful sperm retrieval in patients with non‐obstructive azoospermia undergoing salvage microdissection testicular sperm extraction

Caroppo

Castiglioni²,

Campagna³

et al. 2021

Andrology

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Background: Patients with non-obstructive azoospermia with a previously failed conventional testicular sperm extraction may undergo a salvage microdissection testicular sperm extraction with the probability of successful sperm retrieval being almost dependent upon the number of previous surgical attempts and to different histopathologic categories. Objectives: To determine whether the seminiferous tubules pattern and the histological categories could affect the sperm retrieval rate in patients with non-obstructive azoospermia undergoing salvage microdissection testicular sperm extraction after failed conventional testicular sperm extraction. Materials and methods: Seventy-nine patients undergoing unilateral or bilateral salvage microdissection testicular sperm extraction were evaluated. During microdissection testicular sperm extraction, if present, dilated tubules were retrieved, otherwise,tubules with slightly larger caliber than that of the surroundings were removed. When no dilated tubule or tubule with slightly larger caliber was found, not dilated tubules were excised. A prediction model was built with seminiferous tubules pattern and testis histology as covariates.Results: Sperm retrieval was successful in 30 out of 79 patients. The prediction model correctly classified 88.3% of cases, explained the 29.7% variability of the outcome, and significantly predicted the microdissection testicular sperm extraction outcome with a sensitivity of 67.7% and a specificity of 90.2%, Both tubules with slightly larger caliber and not dilated tubules were negatively associated with the chance of retrieving spermatozoa. Among the histological categories, only early maturation arrest was significant to the model (log(SSR) = 0.57 -1.9SDT -3.3NDT -1.76EMA) (where SSR is sperm retrieval rate, SDT is tubule with slightly larger caliber, NDT is not dilated tubule, and EMA is early maturation arrest). The model had a clearly useful discrimination (area under the curve = 0.814), the estimated performance was 0.8105, and internal calibration was acceptable (p > 0.05).

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 88%

Intrasurgical parameters associated with successful sperm retrieval in patients with non‐obstructive azoospermia undergoing salvage microdissection testicular sperm extraction

Caroppo

Castiglioni²,

Campagna³

et al. 2021

Andrology

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“…The management of patients with NOA is to a large extent knowledge based. Thanks to the evidence produced by the literature of the past 20 years, we know with a good approximation that about 57-60% of patients with NOA may be successful in having their testicular sperm retrieved, what clinical conditions are predictive of SSR, that SRR may vary significantly according to testis histology and that micro-TESE provides better results in terms of SRR compared to the other available surgical techniques [61]. What we do not know, due to the inconclusive data provided by the literature, is whether and how should we treat these patients before surgery to maximize the chance of sperm retrieval.…”

Section: Unmet Needs and Future Directionsmentioning

confidence: 99%

Hormonal Treatment of Men with Nonobstructive Azoospermia: What Does the Evidence Suggest?

Caroppo

Colpi²

2021

JCM

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Hormonal stimulation of spermatogenesis prior to surgery has been tested by some authors to maximize the sperm retrieval yield in patients with nonobstructive azoospermia. Although the rationale of such an approach is theoretically sound, studies have provided conflicting results, and there are unmet questions that need to be addressed. In the present narrative review, we reviewed the current knowledge about the hormonal control of spermatogenesis, the relationship between presurgical serum hormones levels and sperm retrieval rates, and the results of studies investigating the effect of hormonal treatments prior to microdissection testicular sperm extraction. We pooled the available data about sperm retrieval rate in patients with low vs. normal testosterone levels, and found that patients with normal testosterone levels had a significantly higher chance of successful sperm retrieval compared to those with subnormal T levels (OR 1.63, 95% CI 1.08–2.45, p = 0.02). These data suggest that hormonal treatment may be justified in patients with hypogonadism; on the other hand, the available evidence is insufficient to recommend hormonal therapy as standard clinical practice to improve the sperm retrieval rate in patients with nonobstructive azoospermia.

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“…The most difficult form of male infertility to treat is azoospermia [5,10,11,13,17,21,24]. Azoospermia is defined as the complete absence of spermatozoa in the ejaculate.…”

Section: Introductionmentioning

confidence: 99%

“…Secretory infertility is caused by hypogonadism, which means a decrease or absence of the hormone-producing function of interstitial endocrinocytes or the spermatogenic function of the germinogenic epithelium with reduced incretory and excretory functions of the testicles [5,10,11,14,22].…”

Section: Introductionmentioning

confidence: 99%

Morpho-Functional Characteristics of the Testicles of Men With Different Forms of Pathospermia

Vorobets¹,

Melnyk²,

Фафула³

et al. 2023

Scientific and practical journal

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The most difficult form of male infertility to treat is azoospermia. It is identified as a complete absence of sperm in the ejaculate. Depending on the nature and causes of impaired spermatogenesis, azoospermia is divided into obstructive (excretory, OA) and non-obstructive (secretory, NOA). Testicular biopsy is the most effective method of diagnosis and a component of possible treatment for azoospermia. It is the only objective method of differential diagnosis between non-obstructive and obstructive forms of azoospermia. The aim: histological analysis of testicular biopsies of men with various forms of azoospermia. Мaterials and Methods. 78 infertile men with azoospermia were examined. They were divided into two groups: the first group, men with NOA (n = 28); the second group, men with OA (n = 50). The biopsy was preceded by a mandatory ultrasound diagnosis of the portal system. The biopsy was performed using the method of open operative access. Biopsies were mostly taken from the more palpable testicle or from both testicles. Biopsies were fixed in buffered 10% formalin (pH 7.2). After 1 day, they were dehydrated in 70% ethanol and embedded in paraffin. For histological studies, sections with a thickness of 5 μm were stained with hematoxylin and eosin. Biopsies were evaluated in accordance with previously described methods. Results. Histological analysis of testicular biopsies from 28.7% of patients with a non-obstructive form of azoospermia showed swelling of the testicular stroma, destructive changes in testosterone-producing cells, disruption of the structure of the syncytial complexes of the spermatogenic epithelium, and the complete absence of the process of spermatogenesis in individual tortuous seminiferous tubules, the absence of contacts between sustentocytes, and in erythrocyte sludge in the lumen of vessels. 42.8% of patients had fibrosis of the testicular stroma, stroma swelling, thinning of the wall of convoluted seminiferous tubules, violation of the structure of the syncytial complexes of the spermatogenic epithelium, proliferation of the wall of the convoluted seminiferous tubules into their lumen, and infiltration of the testicular stroma with lymphocytes. In 54.0% of patients with preserved spermatogenesis and an obstructive form of azoospermia, it was possible to find a history of orchoepididymitis in the anamnesis; one patient (2.0%) underwent bilateral orchopexy at the age of 5 years due to cryptorchidism; 6.0% recalled the trauma calculi in the anamnesis; and 38.0% denied any factors affecting fecundity in the anamnesis. Conclusions. The non-obstructive form of azoospermia is characterized by the following parameters: mostly a violation of the structure of the spermatogenic epithelium, a complete absence of the process of spermatogenesis in individual convoluted seminiferous tubules, a violation of the structure of the hematotesticular barrier, and a violation of blood microcirculation. The histological picture of preserved spermatogenesis is of the same type in 88.0% of patients with an obstructive form of azoospermia. In most tubules, a fixed number of cell rows is preserved, and cells of various stages of spermatogenesis are determined in them: spermatogonies, spermatocytes, a moderate number of spermatids. In the lumen of the tubules, exfoliated cells and a moderate number of spermatozoa are found.

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Re: predictors of surgical sperm retrieval in non-obstructive azoospermia: summary of current literature

Cited by 3 publications

References 17 publications

Intrasurgical parameters associated with successful sperm retrieval in patients with non‐obstructive azoospermia undergoing salvage microdissection testicular sperm extraction

Intrasurgical parameters associated with successful sperm retrieval in patients with non‐obstructive azoospermia undergoing salvage microdissection testicular sperm extraction

Hormonal Treatment of Men with Nonobstructive Azoospermia: What Does the Evidence Suggest?

Morpho-Functional Characteristics of the Testicles of Men With Different Forms of Pathospermia

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