Erdem KOÇ, Fevzi BEDİR, İbrahim KARABULUT, Özkan POLAT

Non-Obstrüktif Azospermide Tek Taraflı Mikroskopik Testiküler Sperm Ekstraksiyonu

Amaç: Çalışmamızda, kliniğimizdeki non-obstrüktif azoospermi (NOA) olgularında tek taraflı mikroskobik testiküler sperm ekstraksiyonu (mTESE) sonuçlarımızı sunmayı ve başarıyı etkileyen faktörleri ortaya koymayı amaçladık.Gereç ve Yöntemler: Çalışmamıza toplam 102 NOA hastası dahil edildi. Hastaların testis hacimleri, serum folikül uyarıcı hormon (FSH), lüteinizan hormon (LH), prolaktin (PRL) ve testosteron (T) düzeyleri ölçüldü, genetik değerlendirmeleri yapıldı. Ardından mTESE uygulanarak hastalar, sperm ekstraksiyonunun başarılı (sperm bulunan) veya başarısız (sperm bulunmayan) olmasına göre iki gruba ayrıldı. Gruplar demografik, klinik ve histopatolojik veriler açısından karşılaştırıldı.Bulgular: mTESE ile sperm ekstraksiyonu başarı oranımız %62.7 idi (n=64). İki grup arasında yaş, infertilite süresi, serum T ve PRL düzeyleri açısından anlamlı fark yoktu (sırasıyla p=0.896, p=0.357, p=0.504, p=0.179). mTESE'nin başarılı olduğu grupta ortalama testis hacmi anlamlı olarak daha yüksek olup, serum FSH ve LH düzeyleri anlamlı olarak düşüktü (sırasıyla p=0.029, p=0.004, p=0.001). Histopatolojik değerlendirmede mTESE başarısı açısından hipospermatogenez, sertoli cell only sendromu (SCOS) ve matürasyon arrest (MA) grupları arasında anlamlı fark bulundu (sırasıyla % 88.5, %37.5, % 30; p<0.001).Sonuç: Tek taraflı mTESE başarı oranımız, daha önce bildirilen bilateral serilerle benzer olarak bulundu. mTESE başarısını etkileyen birden çok prediktif faktör bulunmakla birlikte, tek taraflı mTESE uygulamasının daha az invaziv olması ve kontralateral testis bütünlüğünün korunması nedeniyle kurtarma mTESE açısından avantaj sağlayabilir.

Anahtar Kelimeler:

Non-obstrüktif azoospermia, Mikro-TESE, Sperm elde etme, Unilateral

Unilateral Microscopic Testicular Sperm Extraction in Non-Obstructive Azoospermia

Purpose: We aimed to present the results of unilateral microscopic testicular sperm extraction (mTESE) in non-obstructive azoospermia (NOA) cases in our clinic and to elucidate the factors affecting mTESE success. Materials and Methods: Our study was prospectively designed and 102 NOA patients were included. Testis volumes, serum follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL) and testosterone (T) levels were measured and genetic evaluations were carried out. We performed mTESE and divided patients into two groups according to sperm extraction results as mTESE is successful (sperm could be found) or failed (sperm could not be found). The two groups were compared in demographic, clinical and histopathological data.Results: Sperm extraction by mTESE was successful in 64 (62.7%) patients. There was no significant difference between two groups in terms of age, infertility times, serum T and PRL levels (p=0.896, p=0.357, p=0.504, p=0.179, respectively). Serum FSH and LH levels were significantly lower, and the mean testis volume was significantly higher in the group that micro-TESE was successful (p=0.004, p=0.001, p=0.029, respectively). Histopathological evaluation revealed a significant difference between hypospermatogenesis, sertoli cell only syndrome (SCOS) and maturation arrest (MA) groups in terms of mTESE success (88.5%, 37.5%, 30%, respectively; p<0.001).Conclusion: Our unilateral mTESE success rate was similar to those performed bilaterally in literature. Besides the multiple predictive factors of mTESE success rate, unilaterally performed mTESE is less invasive procedure preserving the integrity of the contralateral testis and may be advantageous in terms of improving salvage mTESE results.

Keywords:

Non-obstructive azoospermia, Micro-TESE, Sperm retrieval, Unilateral,

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