| Autor: |
I., Sinescu, S., Voinea, I., Manea, B., Haineală, C., Gagiu, A., Preda, C., Pavel, L., Ladislau, M., Hârza, M., Matei, G., Dohle |
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| Zdroj: |
Romanian Journal of Urology; Dec2009, Vol. 8 Issue 4, p49-52, 4p, 2 Charts |
| Abstrakt: |
Introduction The aim of scrotal exploration in patients with obstructive azoospermia (OA) is to perform reconstruction of spermatic tract and to retrieve sperm using microsurgical epididymal sperm aspiration (MESA). Reconstruction is performed only if viable spermatozoa are found in the epididymis. The outcome of scrotal exploration in patients with OA secondary to previous vasectomy largely depends on the interval (in years) between vasectomy and reversal operation. The outcome of primary OA, unrelated to prior vasectomy has been less studied. Normal testicular volume and epididymal distension together with normal FSH are the main clinical argue for OA. To date, no non-invasive clinical criteria has shown to be of predictive value for the outcome of MESA in patients with primary OA. Objective The objective of this study was to find a correlation between clinical preoperative data and the presence of viable spermatozoa with MESA in patients with primary OA. Material and methods 30 patients (mean age 32.17, range 26-40 years) were prospectively included between September 2008 and September 2009, using the following criteria for primary OA: vas deferens clinically present; seminal volume ≥1mL, semen pH≥7, seminal fructose present; normal reproductive hormones; at least one testicle with volume ≥10cc and width of epididymis caput ≥5mm as measured by ultrasound. Patients with history of vasectomy, attempted microsurgical reconstruction and congenital absence of vas deferens (CAVD) were excluded. All patients underwent scrotal exploration with the aim to perform MESA and, if possible, reconstruction of the spermatic tract. The entire cohort was divided into 2 groups: group 1 with viable sperm - successful MESA and group 2 with absent /dead sperm - unsuccessful MESA. Correlations of variables with outcome of MESA were calculated using SPSS software and by comparison the 2 groups. Results The testicles were analyzed independently. MESA was successful in 32 (55.17%) and unsuccessful in 26 (44.82%) testicles (tow patient has solitary testicle). In this cohort the only significant correlation with OA was found with the width of epididymis caput; an epididymal caput > 8.5mm was predictive for finding viable spermatozoa (sensitivity 71.9%, specificity 71.4%). Conclusion This report aimed to predict the success of MESA using objective clinical variables. So far, only the width of the caput of the epididymis was significantly associated with the presence of viable spermatozoa in epididymis. Nevertheless, as about 30% can be omitted using this parameter (false negative rate), scrotal exploration is still indicated in all patients with fulfilling the criteria for primary OA. [ABSTRACT FROM AUTHOR] |
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