(126) ROLE OF TESTICULAR BIOPSY IN GUIDING MICRODISSECTION TESTICULAR SPERM EXTRACTION IN NON-OBSTRUCTIVE AZOOSPERMIA: A SINGLE-CENTER RETROSPECTIVE STUDY
Notice bibliographique
Résumé
Abstract Introduction Non-obstructive azoospermia (NOA) is characterized by the absence of sperm in the ejaculate due to testicular failure. Testicular biopsy may play a crucial role in evaluating and managing NOA by providing valuable diagnostic information and guiding treatment decisions. Performing a testicular biopsy before microdissection testicular sperm extraction (mTESE) can determine the presence and degree of spermatogenesis, evaluate the feasibility of sperm retrieval, optimize the surgical approach, and contribute to patient counselling during a fertility workup. Minimal literature exists describing the utility of a testicular biopsy prior to an mTESE in the management of NOA. Objective The primary aim of this study is to evaluate the role of testicular biopsy in the assessment and management of NOA and to determine the necessity and willingness of patients to undergo further mTESE procedures based on the pathological findings. Methods This retrospective single-center study included adult males with NOA meeting criteria of two consecutive semen analyses demonstrating azoospermia, FSH levels >8 mIU/mL and normal karyotype/Y chromosome microdeletion (YCMD). Data was extracted from medical charts of patients seen by a single surgeon between September 2022 and June 2024. Demographic variables (age, BMI, FSH levels) and histopathology findings from testicular biopsies were collected ranging from Sertoli cell-only syndrome (SCO), hypospermatogenesis, and maturation arrest to normal testicular tissue. Linear regression analysis was performed to determine if histopathology types predicted patient decisions to undergo mTESE. Results This study examined the relationship between testicular histopathology and mTESE decisions in 19 patients (mean age 35.9 ± 5.5 years, BMI 26.9 ± 4.4 kg/m2, FSH 22.0 ± 15.8 mIU/mL). 68.4% had homogenous pathology, 26.3% had two pathologies, and 5.3% had three pathologies. Hypospermatogenesis was most common (46.2%), followed by SCO (38.5%) and maturation arrest (15.4%). Logistic regression analysis revealed that the odds of choosing mTESE increased by a factor of 5.33 (CI95%: 1.23-23.14) for each additional pathology observed. Patients with hypospermatogenesis were 3.08 times more likely to opt for mTESE compared to other pathologies (CI95%: 1.42-6.67). The probability of choosing mTESE increased from 42.86% for one pathology to 95.24% for three pathologies, with 30.77% of hypospermatogenesis, 19.23% of SCO, and 15.38% of maturation arrest patients opting for the procedure. Conclusions This single-center retrospective study underscores the pivotal role of testicular biopsy in the management of NOA. Histopathologic findings from testicular biopsies significantly influenced patients' decisions to proceed with a mTESE, with those diagnosed with hypospermatogenesis demonstrating a strong inclination towards pursuing mTESE. These findings highlight the clinical utility of histopathological assessment in guiding personalized treatment for NOA patients, optimizing the effectiveness of fertility interventions and enhancing patient counselling during fertility evaluations. Future prospective studies should further validate these findings across diverse patient populations to refine clinical algorithms for effective NOA management. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Dr. Premal Patel has been a consultant for Boston Scientific.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».