Osman BARUT, Sefa RESİM, Mehmet Kutlu DEMİRKOL

Nonobstruktif Azospermide Mikrocerrahi Testiküler Sperm Ekstraksiyonu ile Sperm Bulmada Prediktif Faktörlerin Değerlendirilmesi

Amaç: Non-obstrüktif azoospermili (NOA) infertil erkeklerde mikrodiseksiyon testiküler sperm ekstraksiyonu (mikro TESE) ile sperm bulma başarı-sını etkileyen faktörleri araştırmak. Gereç ve Yöntem: Ocak 2015 ile Şubat 2020 tarihleri arasında NOA nedeniyle mikro TESE operasyonu yapılan toplam 75 hastanın verileri geriye dönük olarak değerlendirildi. Tüm hastaların fizik muayene, hormon değerleri, testis hacimleri ve histopatolojik bulguları kaydedildi. Bulgular: Yetmişbeş erkekten 41 (%54,7)'i mikro TESE pozitif iken 34 (%45,3)'ü mikro TESE negatifti. Mikro TESE pozitif olan hastaların medyan yaşı 32,5 (22-54) yıl, negatif olanların 32 (26-48) yıl olarak saptandı (p =0,515). TESE pozitif ve negatif hasta grupları infertilite süresi, sağ ve sol testis hacmi bakımından karşılaştırıldığında anlamlı farklılık saptanmadı (sırasıyla; p =0,595, p =0,060 ve p =0,113). Mikro TESE pozitif hasta gru-bunda medyan folikül uyarıcı hormon (FSH) düzeyi 6,25 (0,30-47,30) IU/L iken mikro TESE negatif grupta 9,10 (0,80-66,40) IU/L idi ve istatistiksel olarak anlamlıydı (p =0,048). Hipospermatogenezli hastalarda maturasyon arresti, Sertoli cell only ve fibrozisi olanlara göre daha yüksek sperm elde etme oranının olduğu görüldü (sırasıyla; %93,1, %37,9, %27,3, %16,7). Sonuç: FSH düzeyi ve testiküler histopatolojinin mikro TESE’de sperm bulma başarısını etkileyen önemli prediktif faktörler olduğu görülmektedir.

Evaluation of Predictive Factors in Sperm Finding by Microsurgical Testicular Sperm Extraction in Nonobstructive Azoospermia

Objective: To investigate the factors affecting the success of sperm retrieval by microdissection testicular sperm extraction (micro TESE) in infertile men with non-obstructive azoospermia (NOA). Material and Method: Data of 75 patients who underwent micro TESE operation for NOA between January 2015 and February 2020 were evaluated retrospectively. Physical examination, hormone values, testicular volumes and histopathological findings of all patients were recorded. Results: Of the 75 men, 41 (54.7%) were positive for micro TESE, while 34 (45.3%) were negative for micro TESE. The median age of patients with positive micro-TESE was 32.5 (22-54), and the median age of those who were negative was 32 (26-48) (p =0.515). When TESE positive and negative patient groups were compared in terms of duration of infertility and right and left testicular volume, no significant difference was found (p =0.595, p =0.060 and p =0.113, respectively). While the median follicle stimulating hormone (FSH) level was 6.25 (0.30-47.30) IU/L in the micro-TESE positive patient group, it was 9.10 (0.80-66.40) IU/L in the micro TESE negative group and it was statistically significant (p =0.048). It was observed that patients with hypospermatogenesis had a higher sperm retrieval rate than those with maturation arrest, Sertoli cell only and fibrosis (93.1%, 37.9%, 27.3%, 16.7%, respectively). Conclusion: It is seen that FSH level and testicular histopathology are important predictive factors affecting the success of sperm finding in micro TESE.

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