Prior studies have investigated sperm retrieval rates in men with nonobstructive azoospermia (NOA) secondary to specific etiologies, yet most cases of NOA are idiopathic. We compared sperm retrieval rates and testicular histopathology in idiopathic NOA (iNOA) and nonidiopathic NOA (niNOA). We performed a retrospective review of men with NOA who underwent microdissection testicular sperm extraction (microTESE) between 2000 and 2016. Men with no history of malignancy or cryptorchidism and negative genetic evaluation were considered idiopathic. Multivariable regression determined the association between idiopathic etiology and primary outcomes of sperm retrieval and active spermatogenesis on histopathology. Among 224 men, 86 (38.4%) were idiopathic, 75 (33.5%) were nonidiopathic, and 63 (28.1%) did not undergo genetic testing. Median age and serum testosterone were higher among iNOA or no testing versus niNOA. Median follicle-stimulating hormone (FSH) was lower among iNOA or no testing versus niNOA. A higher proportion of iNOA or no testing versus niNOA had a clinical varicocele. Sperm retrieval rates were similar between iNOA, niNOA, and no testing (41.8% vs 48.0% vs 55.6%, respectively; P = 0.255). Active spermatogenesis was seen in a higher proportion of iNOA or no testing versus niNOA (31.4% and 27.0% vs 16.0%, P = 0.073). On multivariaile analysis, iNOA was not associated with sperm retrieval or spermatogenesis (P = 0.430 and P = 0.078, respectively). Rates of sperm retrieval and spermatogenesis on testis pathology were similar in men with iNOA and niNOA. These data will be useful to clinicians in preoperative counseling for men with NOA and negative genetic evaluation.

译文

:先前的研究调查了继发于特定病因的非阻塞性无精子症(NOA)男性的精子回收率,但大多数NOA病例是特发性的。我们比较了特发性NOA(iNOA)和非特发性NOA(niNOA)的精子回收率和睾丸组织病理学。我们对2000年至2016年间进行了显微解剖睾丸精子提取术(microTESE)的NOA男性进行了回顾性研究。无恶性或隐睾病史和阴性基因评估的男性被认为是特发性的。多变量回归确定了特发性病因与精子取回的主要结果以及组织病理学上活跃的精子发生之间的关系。在224名男性中,有86名(38.4%)是特发性的,有75名(33.5%)是非特发性的,有63名(28.1%)没有接受基因测试。在iNOA或未进行检测的患者中,年龄中位数和血清睾丸激素水平高于niNOA。与niNOA相比,iNOA或未经测试的中位卵泡刺激素(FSH)较低。与niNOA相比,iNOA较高或未进行测试的患者有临床精索静脉曲张。 iNOA,niNOA和未检测的精子回收率相似(分别为41.8%和48.0%和55.6%; P = 0.255)。与niNOA相比,在iNOA或未进行测试的情况下,活跃的精子发生比例更高(31.4%和27.0%对16.0%,P = 0.073)。在多变量分析中,iNOA与精子获取或精子生成无关(分别为P = 0.430和P = 0.078)。 iNOA和niNOA男性的精子取精率和精子发生率对睾丸病理学的影响相似。这些数据将为临床医生在NOA和阴性基因评估的男性的术前咨询中提供帮助。

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