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Prospective evaluation of scrotal ultrasound and intratesticular perfusion by color-coded duplex sonography (CCDS) in TESE patients with azoospermia

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Abstract

Purpose

The objective of this study was to assess whether CCDS might improve the outcome of testicular sperm retrieval in patients with azoospermia. Furthermore, we evaluated potential sonographic alterations of the testis before and after trifocal and Micro-TESE.

Methods

78 patients were enrolled prospectively: 24 with obstructive azoospermia (OA) and 54 with non-obstructive azoospermia (NOA). 31 of 54 patients in the NOA group had negative surgical sperm retrieval. Testicular volume, hormonal parameters and sonographical findings were compared before and after TESE. The spermatogenetic score was determined for all retrieval sites. CCDS was performed at the upper, middle and lower segment of the testis. Ultrasound parameters and peak systolic velocity (PSV) were measured pre- and post-operatively.

Results

Testicular volume and epididymal head size were significantly increased in OA patients compared to NOA patients. Ultrasound parameters were comparable between NOA patients with and without successful sperm retrieval. A higher intratesticular PSV was significantly correlated with a better spermatogenic score in the corresponding sonographic position. However, after adjustment for other clinical confounders, PSV does not show a significant influence on the spermatogenic score. Testicular volume decreased significantly in all patients post-operatively after 6 weeks (p < 0.001). Finally, the PSV significantly increased in all patients 24 h after surgery and nearly returned to baseline levels after 6 weeks (p < 0.001).

Conclusions

A higher intratesticular PSV may be helpful as a pre-operative diagnostic parameter in mapping for better sperm retrieval, but CCDS does not help to predict successful testicular sperm retrieval after adjustment for other clinical confounders.

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Acknowledgements

This study was supported by the DFG (German Research Foundation), KFO 181-2, Proj. 8: Atherosclerosis-related disturbances of spermatogenesis: lessons from the ApoE-/-/LDL receptor-/- knockout mouse model and prospective investigations in men.

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Authors and Affiliations

  1. Department of Urology, Pediatric Urology and Andrology, Justus-Liebig University Giessen, Rudolf-Buchheim-Str. 7, 35392, Giessen, Germany

    Bora Altinkilic, Adrian Pilatz, Thorsten Diemer, Julia Wolf, Hans-Christian Schuppe & Wolfgang Weidner

  2. Institute of Veterinary Anatomy, Histology and Embryology, Justus-Liebig University Giessen, Frankfurter Str. 98, 35392, Giessen, Germany

    Martin Bergmann

  3. Department of Statistics, TU Dortmund University, Dortmund, Germany

    Sarah Schönbrunn & Uwe Ligges

Authors
  1. Bora Altinkilic
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  2. Adrian Pilatz
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  3. Thorsten Diemer
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  4. Julia Wolf
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  5. Martin Bergmann
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  6. Sarah Schönbrunn
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  7. Uwe Ligges
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  8. Hans-Christian Schuppe
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  9. Wolfgang Weidner
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Contributions

BA: Project development, Data collection, Manuscript writing. AP: Project development, Data collection, Data analysis. TD: Project development, Data collection, Manuscript editing. JW: Data collection, Data analysis. MB: Data collection. SS: Data analysis. UL: Data analysis. HCS: Project development, Data collection. WW: Project development, Manuscript editing.

Corresponding author

Correspondence to Bora Altinkilic.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the local institutional review board (Ref. No. 26/11).

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Informed consent was obtained from all individual participants included in the study.

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Altinkilic, B., Pilatz, A., Diemer, T. et al. Prospective evaluation of scrotal ultrasound and intratesticular perfusion by color-coded duplex sonography (CCDS) in TESE patients with azoospermia. World J Urol 36, 125–133 (2018). https://doi.org/10.1007/s00345-017-2039-z

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