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Ohta T, Kojo K, Kurobe M, Numahata D, Tatsuya T, Okada S, Iwamoto T. Feasibility of high-frequency ultrasound for seminiferous tubule assessment and correlation of B-mode imaging with pathological findings in the testis in azoospermia. J Med Ultrason (2001) 2024:10.1007/s10396-024-01462-8. [PMID: 38710922 DOI: 10.1007/s10396-024-01462-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 04/03/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE To determine the feasibility of high-frequency ultrasound (HFUS) for assessing seminiferous tubules and to understand high-resolution B-mode images of the testes in cases of azoospermia. METHODS We verified how the histopathological images of testicular biopsy specimens can be observed using HFUS images and measurement analysis of seminiferous tubules was performed to 28 testes of 14 cases with azoospermia who underwent preoperative ultrasound and microdissection testicular sperm extraction (micro-TESE). The population consisted of obstructive azoospermia (OA) and non-obstructive azoospermia (NOA), including Sertoli cell-only syndrome (SCOS), and the other pathologies. Statistical verification of differences in seminiferous tubule diameters among preoperative ultrasound examination, ultrasound examination of pathological specimens, and histopathological specimens. We also examined the imagingpathology correlation via a case series presentation, aiming to identify imaging markers of testicular pathology and determine the possibility of predicting each condition. RESULTS A comparison between HFUS images and histopathology from the same biopsy specimens suggested that ultrasonography could be seen as stereoscopic images due to its significantly greater slice thickness. The diameters of tubules were generally larger in pathological tissues as compared to ultrasonographic findings in OA and SCOS, but not in the other conditions. Comparisons provided insights into the predictability of SCOS and revealed imaging findings such as gaps between tubules and decreased diameter reflective of testicular damage. CONCLUSION Seminiferous tubules can be observed however the diameter of seminiferous tubules varies in imaging and histopathology depending on the pathology. Imaging findings that reflect testicular damage and the predictability of SCOS were revealed in this study, but further verification is required.
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Affiliation(s)
- Tomoyuki Ohta
- Department of Radiology, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara, Tochigi, 329-2763, Japan.
| | - Kosuke Kojo
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- Center for IVF and Infertility, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Masahiro Kurobe
- Center for IVF and Infertility, International University of Health and Welfare Hospital, Tochigi, Japan
- Department of Urology, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Daisuke Numahata
- Center for IVF and Infertility, International University of Health and Welfare Hospital, Tochigi, Japan
- Department of Urology, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Takayama Tatsuya
- Center for IVF and Infertility, International University of Health and Welfare Hospital, Tochigi, Japan
- Department of Urology, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Shinya Okada
- Division of Pathology, Kitasato University Medical Center, Saitama, Japan
| | - Teruaki Iwamoto
- Center for IVF and Infertility, International University of Health and Welfare Hospital, Tochigi, Japan
- Department of Urology, St. Marianna University School of Medicine, Kanagawa, Japan
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Gamidov S, Shatylko T, Popova A, Gasanov N, Sukhikh G. Azoospermic men with isolated elevation of follicle-stimulating hormone represent a specific subpopulation of patients with poor reproductive outcomes. Clin Exp Reprod Med 2022; 49:62-69. [PMID: 35172538 PMCID: PMC8923626 DOI: 10.5653/cerm.2021.04623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/27/2021] [Indexed: 12/03/2022] Open
Abstract
Objective This study aimed to describe a distinct subpopulation of azoospermic patients with isolated elevation of follicle-stimulating hormone (iFSH) and poor outcomes of microdissection testicular sperm extraction (microTESE). Methods A retrospective analysis of microTESE outcomes was conducted among 565 patients with non-obstructive azoospermia (NOA). Testicular pathology was assessed by the dominant histological pattern and Bergmann-Kliesch score (BKS). Descriptive statistics were presented for the iFSH subgroup. Inhibin B levels, the sperm retrieval rate (SRR), and BKS were compared in iFSH patients and other NOA patients. Results The overall SRR was 33.3% per microTESE attempt. The median BKS was 0.6 (interquartile range, 0–2). Of all NOA patients, 132 had iFSH, and microTESE was successful only in 11 of those cases, with an SRR of 8.3%, while the total SRR in other NOA patients was 38.1% (p<0.001). iFSH had a sensitivity of 32.1% (95% confidence interval [CI], 27.4%–36.8%) and specificity of 94.1% (95% CI, 90.8–97.5%) as a predictor of negative microTESE outcomes. Conclusion Patients with iFSH may harbor a distinct testicular phenotype with total loss of the germ cell population and poor outcomes of surgical sperm retrieval.
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Affiliation(s)
- Safar Gamidov
- Department of Andrology and Urology, V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Moscow, Russia
- Department Obstetrics, Gynecology, and Perinatology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Taras Shatylko
- Department of Andrology and Urology, V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Moscow, Russia
- Corresponding author: Taras Shatylko Department of Andrology and Urology, V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Oparina St, 4, Moscow 117997, Russia Tel: +79276204925 E-mail:
| | - Alina Popova
- Department of Andrology and Urology, V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Moscow, Russia
| | - Natig Gasanov
- Department of Andrology and Urology, V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Moscow, Russia
| | - Gennadiy Sukhikh
- Department of Andrology and Urology, V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Moscow, Russia
- Department Obstetrics, Gynecology, and Perinatology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Ernandez J, Berk B, Han T, Abou Ghayda R, Kathrins M. Evaluating the quality of reported outcomes for microsurgical TESE in men with non-obstructive azoospermia: A methodological analysis. Andrology 2021; 9:1108-1118. [PMID: 33675583 DOI: 10.1111/andr.12997] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Publications of microsurgical testicular sperm extraction (mTESE) techniques and outcomes are heterogeneous, which may limit creation of best surgical practices. OBJECTIVE To study the quality and heterogeneity of published mTESE outcomes via a methodological analysis. MATERIALS/METHODS A systematic methodological analysis of all published literature on the use of mTESE in men with non-obstructive azoospermia from 1999 to the July 2020 was performed. PubMed and MEDLINE searches were performed using the search terms "microdissection TESE OR microsurgical TESE." Publications were evaluated on their reporting of pre-operative factors, intraoperative techniques, surgical and clinical outcomes, and adverse events. RESULTS Fifty-five studies met inclusion criteria. Surgical technique and sperm retrieval rates were the most reported criteria. Reporting on the presence of an embryologist intraoperatively was observed in approximately 30% of articles, while other procedural details including method of sperm quantification, quantity retrieved, and number of cryopreserved vials were observed in fewer than 10% of articles. Clinical outcomes, including pregnancy rates and live birth rates, were reported in fewer than 40% of the articles. Fetal outcomes including fetal and neonatal anomalies were rarely reported. Fetal growth restriction, preterm delivery, small or large for gestational age, and NICU admissions were never reported. CONCLUSION There are inconsistencies in reporting quality of mTESE outcomes, specifically a lack of information on the quantity and quality of sperm retrieved, the role of embryology intraoperatively, and clinical outcomes, such as live birth rate and fetal anomalies. These gaps may guide development of standardized reporting guidelines to better assess and compare clinical outcomes across institutions and maintain focus on couples-centric fertility outcomes in future mTESE studies.
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Affiliation(s)
| | - Brittany Berk
- Division of Urology, Brigham and Women's Hospital, Boston, MA, USA
| | - Tracy Han
- Division of Urology, Brigham and Women's Hospital, Boston, MA, USA
| | - Ramy Abou Ghayda
- Department of Urology, Case Western Reserve University, Cleveland, OH, USA
| | - Martin Kathrins
- Division of Urology, Brigham and Women's Hospital, Boston, MA, USA
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Ghanami Gashti N, Sadighi Gilani MA, Abbasi M. Sertoli cell-only syndrome: etiology and clinical management. J Assist Reprod Genet 2021; 38:559-572. [PMID: 33428073 PMCID: PMC7910341 DOI: 10.1007/s10815-021-02063-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/02/2021] [Indexed: 12/28/2022] Open
Abstract
Almost 50% of infertility cases are due to male factors, and spermatogenesis failure is one of the most severe forms of male infertility. Sertoli cell-only syndrome (SCOS) also known as germ cell aplasia is characterized by azoospermia in which the seminiferous tubules of testicular biopsy are lined only with Sertoli cells. The definitive diagnosis of SCOS is by diagnostic testicular biopsy. Although SCOS may be a result of Klinefelter syndrome, most of the SCOS men have a normal karyotype. Along with genetic aberrations, signaling pathways and endocrine processes might be major factors in the development of SCOS. Sperm retrieval and intracytoplasmic sperm injection (ICSI) are available treatments for SCOS. However, some SCOS patients do not have therapeutic options to help them having a biological child. This review aims to summarize our present knowledge about SCOS and to highlight the importance of future researches in the diagnosis and treatment of this disorder.
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Affiliation(s)
- Nasrin Ghanami Gashti
- Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sadighi Gilani
- Department of Urology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mehdi Abbasi
- Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Flannigan RK, Schlegel PN. Microdissection testicular sperm extraction: preoperative patient optimization, surgical technique, and tissue processing. Fertil Steril 2019; 111:420-426. [PMID: 30827516 DOI: 10.1016/j.fertnstert.2019.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 01/02/2019] [Indexed: 11/29/2022]
Abstract
Infertility due to nonobstructive azoospermia is treatable with the use of testicular sperm extraction and IVF. The optimal approach for sperm retrieval is microdissection testicular sperm extraction (mTESE). This systematic review summarizes and evaluates the literature pertaining to patient optimization before mTESE, mTESE technique, and post-mTESE testicular tissue processing. Preoperative patient optimization has been assessed in terms of adjuvant hormone therapy and varicocele repair. Limited data are available for adjuvant medical therapy, and although also limited, data for varicocele repair support increased sperm retrieval, pregnancy, and return of sperm to the ejaculate. Post-mTESE tissue processing has few comparative studies; however, most studies support the combination of mechanical mincing and use of type 4 collagenase for tissue disintegration along with pentoxifylline to assist in identifying motile and viable spermatozoa for intracytoplasmic sperm injection.
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Affiliation(s)
- Ryan K Flannigan
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Weill Cornell Medicine, Department of Urology, New York, New York
| | - Peter N Schlegel
- Weill Cornell Medicine, Department of Urology, New York, New York.
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