Welcome to PracticeUpdate! We hope you are enjoying temporary access to this content.
Please register today for a free account and gain full access
to all of our expert-selected content.
Already Have An Account? Log in Now
Ultrasonographically Determined Size of Seminiferous Tubules Predicts Sperm Retrieval by Microdissection Testicular Sperm Extraction
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersOBJECTIVE
To investigate the value of the ultrasonographically determined size of seminiferous tubules and other conventional parameters for predicting sperm retrieval by microdissection testicular sperm extraction (micro-TESE).
DESIGN
Clinical retrospective study.
SETTING
Two urological clinics.
PATIENT(S)
Eight hundred six men with nonobstructive azoospermia.
INTERVENTION(S)
Micro-TESE.
MAIN OUTCOME MEASURE(S)
Sperm retrieval.
RESULT(S)
Sperm retrieval was successful in 240 (29.8%) of the 806 men. In a receiver operating characteristic analysis of sperm retrieval, the area under the curve (AUC) for seminiferous tubules, assessed as 0, 100, 200, 250, or 300 μm, was no less than 0.82 (95% confidence interval [CI] 0.79-0.85). Sensitivity and specificity at a cutoff point of 250 μm were 76.7% and 80.7%, respectively. An AUC of 0.85 (95% CI, 0.81-0.88) was attained in a parsimonious multiple logistic regression model that included age (<30, 30-39, and 40-59 years), low follicle-stimulating hormone (<14 IU/L), history of cryptorchidism, and sex chromosome abnormality in addition to the diameter of seminiferous tubules.
CONCLUSION(S)
The gray-scale image in testicular ultrasound was shown to be highly predictive of sperm retrieval in micro-TESE in a large series of men with nonobstructive azoospermia.
Additional Info
Disclosure statements are available on the authors' profiles:
Ultrasonographically Determined Size of Seminiferous Tubules Predicts Sperm Retrieval by Microdissection Testicular Sperm Extraction in Men With Nonobstructive Azoospermia
Fertil. Steril 2020 Jan 01;113(1)97-104.e2, S Nariyoshi, K Nakano, G Sukegawa, T Sho, Y TsujiFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The authors present data on preoperative evaluation of seminiferous tubular size in men with nonobstructive azoospermia and its value for predicting the chance of sperm retrieval in men with this condition. Nonobstructive azoospermia is a challenging condition because sperm production is so poor that no sperm are able to reach the ejaculate. Prediction of sperm retrieval is difficult preoperatively because most characteristics (eg, testicular volume, FSH) predict overall testicular function, not the highest functioning segment of the testis, which is what determines sperm retrieval chances. Prior imaging approaches have attempted to evaluate the sperm-producing capacity of the testis, and generally can help distinguish normal from abnormal testes. Imaging techniques applied to individual tubules (eg, multiphoton microscopy, OCT) to have been successful have required direct access to tissue, so they require surgery. Current techniques of direct microsurgical examination of testicular tissues, typically with microdissection testicular sperm extraction (microTESE), are the gold standard to identify sites of sperm production and retrieve sperm. The questions of who will succeed with this treatment and who will not are critical for patient counseling.
In this manuscript, the authors describe the predictive value of identifying seminiferous tubules larger than 250 microns as having 71% specificity and 81% sensitivity for finding sperm during attempted sperm retrieval surgery. This predictive value is far better than any combined set of clinical variables that have been previously evaluated. If validated, this is a remarkable predictive value for a single clinical factor. The extension of this testing approach to other centers is critically important, before the widespread acceptance of this analysis.
In my experience, evaluation of the average testicular tubule size does not reflect the best area of sperm production, which could be a focal enlarged seminiferous tubule. Because sperm retrieval is dependent on the focal largest tubule, I suspect that the testicular tubules evaluated with this technique will not predict the results of the most effective microTESE procedures. These results are different from simple biopsies or other limited sampling of testicular tissue in men with nonobstructive azoospermia.