Ultrasonographically determined size of seminiferous tubules predicts sperm retrieval by microdissection testicular sperm extraction in men with nonobstructive azoospermia

Abstract

Objective: To investigate the value of the ultrasonographically determined size of seminiferous tubules and other conventional parameters for predicting sperm retrieval by microdissection testicular sperm extraction (micro-TESE). Design: Clinical retrospective study. Setting: Two urological clinics. Patient(s): Eight hundred six men with nonobstructive azoospermia. Intervention(s): Micro-TESE. Main Outcome Measure(s): Sperm retrieval. Result(s): Sperm retrieval was successful in 240 ( 29.8%) of the 806 men. In a receiver operating characteristic analysis of sperm retrieval, the area under the curve (AUC) for seminiferous tubules, assessed as 0, 100, 200, 250, or 300 mm, was no less than 0.82 (95% confidence interval [CI] 0.79-0.85). Sensitivity and specificity at a cutoff point of 250 mm were 76.7% and 80.7%, respectively. An AUC of 0.85 (95% CI, 0.81-0.88) was attained in a parsimonious multiple logistic regression model that included age (<30, 30-39, and 40-59 years), low follicle-stimulating hormone (<14 IU/L), history of cryptorchidism, and sex chromosome abnormality in addition to the diameter of seminiferous tubules. Conclusion(s):The gray-scale image in testicular ultrasound was shown to be highly predictive of sperm retrieval in micro-TESE in a large series of men with nonobstructive azoospermia.

Three-Dimensional Analysis of Busulfan-Induced Spermatogenesis Disorder in Mice

“…Many clinical factors, such as testicular volume, serum follicle-stimulating hormone, and serum inhibin B, have been investigated as an accurate predictor, but none were useful. Recently, the ultrasonographically measured size of seminiferous tubules was reported as a strong predictor (Nariyoshi et al, 2020). Identifying the focal areas containing mature sperm by ultrasonography mostly depends on the skill of the technician, and if the probable areas were known in advance, the success rate of the identification may increase.…”

Novel methods to enhance surgical sperm retrieval: a systematic review

“…For US, outcomes are highly dependent on the skills of the operator. For example, Nariyoshi et al [ 38 ] included patients from two separate clinics in Japan in their research with US-guided sperm retrievals. This could have allowed a variety of factors to potentially impact the results.…”

“…Elimination of eyepieces allows for better surgical posture [21] Simple to use and easy to transport May allow for shorter surgery times [21] Wider FOV and longer DOF eliminates need for frequent repositioning [22] 3D viewing monitors provides optimal teaching/ demonstration environment [23] Cost Surgical assistants have rotated surgical view, which can lead to confusion during operation [24] Ultrasonography Fast, easy, portable [28] Widely available [28] Ability to locate areas of high perfusion [33] Help rule out areas of absent spermatogenesis [31] Improve success rates of sperm retrievals [36,37] Operator dependent [38] Requires training and experience [38] Difficulty with resolving microvasculature of the testicle [31] Artificial Intelligence Automated assessment of extracted sperm [37,38,44] Real-time analysis of sperm [37] Ability to work with unstained images [37] High accuracy [37] Ability to predict outcomes prior to extraction [41] Avoid operator dependence [43] Training phase of AI can be limited by the number of sperm images available [39] Limited by quality of microscopy images [39] Technology is not widely available Requires collaboration between computer scientists and clinicians FOV: field of view; DOF, depth of field.…”

18F‐FDG PET/CT use in functional assessment of the testes: A systematic review

“…Currently, andrological surgeons identify which seminiferous microtubules to harvest for further use in ART based on the visual assessment of the tubules under a microscope during a micro-TESE procedure. Even though the PET image resolution of 3-4 mm is around 30-40 times greater than the diameter of seminiferous tubules, [42][43][44] localised uptake in a particular region of the testis would allow for some surgical guidance which theoretically could be more accurate than visual assessment alone.…”