Microdissection TESE (mTESE) following adult orchidopexy for undescended intra-abdominal and inguinal testicles - surgical techniques and outcomes from a single-centre cohort.
cryptorchidism
microdissection TESE
orchidopexy
sperm retrieval
undescended testicle
Journal
Andrology
ISSN: 2047-2927
Titre abrégé: Andrology
Pays: England
ID NLM: 101585129
Informations de publication
Date de publication:
01 2020
01 2020
Historique:
received:
05
12
2018
revised:
03
06
2019
accepted:
14
06
2019
pubmed:
12
7
2019
medline:
22
1
2021
entrez:
12
7
2019
Statut:
ppublish
Résumé
Adult undescended testicles (UDTs) often present to fertility specialists with subfertility or azoospermia and with either an intra-abdominal or inguinal testicle(s). Performing an orchidopexy followed by a surgical sperm retrieval (SSR) is a potential option to retrieve spermatozoa. A microdissection TESE (mTESE) procedure is performed to retrieve mature spermatozoa for use in ICSI. This paper reviews the outcomes of mTESE in adults following an orchidopexy. A cohort of azoospermic patients underwent adult orchidopexy over a 10-year period at a single specialist centre. Data were collected retrospectively from the patient records retrieved from an institutional database. All patients underwent pre-operative imaging to localize the testicles, serum testosterone levels and a semen analysis. Separate intraoperative testicular biopsies were performed to exclude intratubular germ cell neoplasia (ITGCN) and to analyse the Johnsen score. Twelve patients (age range 18-36 years) underwent orchidopexy procedures for either intra-abdominal or inguinal testicles. Mean follow-up was 34 months (range 13-58). Ninety per cent of patients had bilateral UDT with azoospermia. Pre-operative testosterone levels were within the normal range (mean 13.9 nmol/L; range 9.1-24.2). Five pelvic testicles (from four patients) were brought down and underwent a delayed mTESE. A total of nine inguinal orchidopexy procedures were carried out in eight men, and spermatozoa were found and preserved in three patients. None of the men with intra-abdominal testicles had mature spermatozoa present following a delayed mTESE. Overall, SSR was successful in 37.5% of the patients. Histological analysis showed no cases of ITGCN and the Johnsen scores ranged from 1 to 3.3. Microdissection TESE following orchidopexy for inguinal testicles can result in a successful SSR in over 1/3rd of patients. Intra-abdominal testicles appear to lack spermatogonia although the testicles can still be preserved for endogenous hormone production. Adult orchidopexy allows preservation of endogenous testosterone, easier self-examination and an immediate or delayed mTESE in azoospermic patients.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
166-170Subventions
Organisme : NIHR Biomedical Research Centre University College London Hospital
Pays : International
Informations de copyright
© 2019 American Society of Andrology and European Academy of Andrology.
Références
Boisen KA, Kaleva M, Main KM, Virtanen HE, Haavisto AM, Schmidt IM, Chellakooty M, Damgaard IN, Mau C, Reunanen M, Skakkebaek NE & Toppari J. (2004) Difference in prevalence of congenital cryptorchidism in infants between two Nordic countries. Lancet 363, 1264-1269.
Buemann B, Henriksen H, Villumsen AL, Westh A & Zachau-Christiansen B. ( 1961) Incidence of undescended testis in the newborn. Acta Chir Scand Suppl Suppl 283, 289 - 293.
Cortes D & Thorup J. (1991) Histology of testicular biopsies taken at operation for bilateral maldescended testes in relation to fertility in adulthood. Br J Urol 68, 285-291.
Elder JS. (2016) Surgical management of the undescended testis: recent advances and controversies. Eur J Pediatr Surg 26, 418-426.
Engeler DS, Hösli PO, John H, Bannwart F, Sulser T, Amin MB, Heitz PU & Hailemariam S. (2000) Early orchiopexy: prepubertal intratubular germ cell neoplasia and fertility outcome. Urology 56, 144-148.
Gracia J, Sánchez Zalabardo J, Sánchez García J, García C & Ferrández A. (2000) Clinical, physical, sperm and hormonal data in 251 adults operated on for cryptorchidism in childhood. BJU Int 85, 1100-1103.
Hadziselimovic F & Herzog B. (2001a) The importance of both an early orchidopexy and germ cell maturation for fertility. Lancet 358, 1156-1157.
Hadziselimovic F & Herzog B. (2001b) Importance of early postnatal germ cell maturation for fertility of cryptorchid males. Horm Res 55, 6-10.
Lee PA. (2005) Fertility after cryptorchidism: epidemiology and other outcome studies. Urology 66, 427-431.
Lin YM, Hsu CC, Wu MH & Lin JS. (2001) Successful testicular sperm extraction and paternity in an azoospermic man after bilateral postpubertal orchiopexy. Urology 57, 365.
Park KH, Lee JH, Han JJ, Lee SD & Song SY. (2007) Histological evidences suggest recommending orchiopexy within the first year of life for children with unilateral inguinal cryptorchid testis. Int J Urol 14, 616.
Pettersson A, Richiardi L, Nordenskjold A, Kaijser M & Akre O. (2007) Age at surgery for undescended testis and risk of testicular cancer. N Engl J Med 356, 1835-1841.
Radmayr C, Dogan HS, Hoebeke P, Kocvara R, Nijman R, Silay R, Undre S & Tekgul S. (2016) Management of undescended testes: European Association of Urology/European Society for Paediatric Urology Guidelines. J Pediatr Urol 12, 335-343.
Schlegel PN. (1999) Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision. Hum Reprod 14, 131-135.
Shah A, Feustel PJ, Knuth J & Welliver C. (2018) An updated mortality risk analysis of the post-pubertal undescended testis. Can Urol Assoc J 13, E1-E6.
Vinardi S, Magro P, Manenti M, Lala R, Costantino S, Cortese MG & Canavese F. (2001) Testicular function in men treated in childhood for undescended testes. J Pediatr Surg 36, 385-388.
Wenzler DL, Bloom DA & Park JM. (2004) What is the rate of spontaneous testicular descent in infants with cryptorchidism? J Urol 171, 849-851.