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Testikuläre Spermienextraktion bei männlicher Infertilität

Indikationen, Erfolgsraten, praktische Durchführung und mögliche Komplikationen

Testicular sperm extraction in male infertility

Indications, success rates, practical implementation, and possible complications

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Zusammenfassung

Hintergrund

Ungewollte Kinderlosigkeit stellt eine Belastung für die Paarbeziehung dar. Das therapeutische Spektrum männlicher Infertilität hat in den letzten Jahren einen deutlichen Zuwachs erfahren, sodass auch Azoospermiepatienten durch eine testikuläre Spermienextraktion (TESE) eine biologische Vaterschaft ermöglicht werden kann.

Ziel der Arbeit

Die Indikationen, Erfolgsraten, praktische Durchführung und mögliche Komplikationen der konventionellen und mikroskopischen TESE bei männlicher Infertilität werden in dieser Arbeit dargestellt.

Material und Methoden

Im Rahmen einer Übersichtsarbeit wurde eine nicht-systematische Recherche der themenrelevanten Literatur durchgeführt.

Ergebnisse

Bei der obstruktiven Azoospermie (OA) werden primär desobstruierende operative Verfahren eingesetzt, die TESE stellt bei der nicht-obstruktiven Azoospermie (NOA) das Operationsverfahren der Wahl dar. Die Spermiengewinnung kann bei letzterer konventionell oder mikroskopisch (mTESE) unterstützt erfolgen, wobei letztere einen Vorteil bezüglich der Spermiendetektionsrate bei kleinen Hodenvolumina (<12 ml), stattgehabter Chemotherapie, Morbus Klinefelter und AZFc-Mikrodeletionen bietet. Die Spermiendetektionsrate der TESE liegt hierbei bei ca. 50 %. Durch die mögliche Induktion eines symptomatischen Hypogonadismus sind postoperative Kontrollen sinnvoll.

Diskussion

Vor Durchführung einer TESE sind eine Bestimmung des Hormonstatus und eine humangenetische Abklärung notwendig. Anfallende Kosten und auch die Möglichkeit eines fehlenden Spermiennachweises müssen besprochen werden. Eine enge Zusammenarbeit zwischen Andrologen, Gynäkologen, Reproduktionsmedizinern und Humangenetikern ist notwendig. Insgesamt ist die TESE ein sicheres und komplikationsarmes Operationsverfahren.

Abstract

Background

Unwanted childlessness is a burden on a couple’s relationship. The therapeutic spectrum of male infertility has increased significantly in recent years so that even azoospermia patients can be given biological paternity by testicular sperm extraction (TESE).

Objectives

The indications, success rates, practical implementation, and possible complications of conventional and microscopic TESE in male infertility are presented in this review.

Methods

A nonsystematic search of the relevant literature was carried out.

Results

In obstructive azoospermia (OA), primarily desobstructive surgical procedures are used, while TESE is the surgical procedure of choice in nonobstructive azoospermia (NOA). In the latter, sperm extraction can be performed conventionally or microscopically (mTESE) assisted, whereby the latter offers an advantage in terms of sperm detection rate in the case of small testicular volumes (<12 ml), chemotherapy, Klinefelter’s disease and AZFc microdeletions. The sperm detection rate of TESE is about 50%. Postoperative controls are useful because of the possible induction of symptomatic hypogonadism.

Conclusion

Before performing TESE, determining the hormone status and human genetic clarification are necessary. Any costs incurred and the possibility of missing sperm proof must be discussed. Close cooperation between andrologists, gynecologists, reproductive physicians, and human geneticists is necessary. All in all, TESE is a safe surgical procedure with a low complication rate.

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  1. Klinik für Urologie und Kinderurologie, St.-Antonius Hospital gGmbH, Dechant-Deckers-Str. 8, 52249, Eschweiler, Deutschland

    J. Rosellen FEBU, FECSM, J. Steffens & J. Kranz

  2. Universitätsklinik und Poliklinik für Urologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland

    J. Kranz

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Rosellen, J., Steffens, J. & Kranz, J. Testikuläre Spermienextraktion bei männlicher Infertilität. Urologe 60, 921–931 (2021). https://doi.org/10.1007/s00120-021-01480-1

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