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  • Spermatogenèse Testiculaires
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Efficacité et innocuité du prélèvement percutané de sperme testiculaire dans la prise en charge de l’infertilité masculine

Efficacy and safety of percutaneous testicular sperm extraction in the management of male infertility

Andrologie volume 13, pages 122–127 (2003)Cite this article

Resume

Objectif

évaluer l’efficacité et l’innocuité des biopsies testiculaires percutanées associées à l’ICSI dans la prise en charge de l’infertilité masculine.

Matériels et méthodes

entre octobre 1995 et décembre 2001, 175 biopsies testiculaires ont été réalisées chez des hommes souffrant d’azoospermie pour fournir des spermatozoïdes en vue d’une fécondation in vitro (FIV) par injection intracytoplasmique de sperme (ICSI). L’azoospermie était obstructive (AO) dans 41 cas et non-obstructive (ANO) dans 134. Les 15 premiers patients dans la série ont bénéficié d’une biopsie chirurgicale, et les autres avaient une biopsie percutanée comme technique de première intention. La biopsie percutanée était réalisée en hospitalisation de jour, sous anesthésie locale, avec un BioptyGun® aiguille 14G.

Résultats

Toutes les biopsies faites pour AO étaient positives, alors que 51/134 (38%) étaient positives dans le groupe ANO. Le matériel fourni par la biopsie percutanée, quand elle était positive, était toujours suffisant pour réaliser l’ICSI. Quand la biopsie percutanée était négative, la biopsie chirurgicale n’a pas donné de meilleurs résultats. Chez les hommes bénéficiant de biopsies percutanées, cinq (3,12%) ont présenté une complication mineure (hématocèle aigüe) nécessitant une exploration scrotale pour hémostase. Il n’y avait aucune complication majeure. Les résultats étaient comparables en termes de fécondation et de grossesses, qu’il s’agisse de sperme frais ou congelé.

Conclusion

la biopsie testiculaire percutanée sous anesthésie locale est un moyen efficace, sûr et peu coûteux pour le prélèvement de spermatozoïdes dans le cadre de la prise en charge de l’infertilité masculine liée à l’azoospermie.

Abstract

Objective

To assess the efficacy and safety of percutaneous testicular biopsy to provide sperm cells for ICSI in male patients with azoospermia not amenable to surgical treatment.

Materials and methods

From October 1995 to December 2001, 175 biopsies were performed in men with azoospermia to provide material for intracytoplasmic sperm injection. Azoospermia was obstructive (OA) in 41 cases and non-obstructive (NOA) in 134 cases. Open biopsy was performed in the first 15 patients in the series and percutaneous biopsy was performed on an outpatient basis, under local anesthesia, with a Biopty Gun® (14G needle), in the subsequent patients as the first step in management. Open surgical biopsies were performed in another 15 patients following a sperm cell-negative percutaneous biopsy.

Results

All biopsies performed for OA were positive, but only 51/134 biopsies (38%) were positive in the NOA group. The material provided by percutaneous biopsy, when positive for sperm cells, was always sufficient to perform ICSI. When percutaneous biopsy was negative, open surgical biopsy failed to give better results. Five men developed minor complications (acute hematocele) following percutaneous biopsies requiring reoperation for hemostasis (3.12%). No major complications were observed. Results were comparable in terms of fertilization and pregnancy rates whether fresh or frozen-thawed sperm was used.

Conclusion

Percutaneous testicular sperm extraction is a safe, well-tolerated and cost-effective procedure in the management of male-factor infertility related to azoospermia.

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Authors and Affiliations

  1. Service d’Urologie, Centre Hospitalier et Universitaire de Pontchaillou, 2 rue Henri Le Guilloux, 35033, Rennes, France

    Maroun Abi Moussa, François Guillé, Georges Kyriakou & Bernard Lobel

  2. CECOS, CHU de Rennes, France

    Jean François Griveau & Dominique Le Lannou

Authors
  1. Maroun Abi Moussa
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  2. François Guillé
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  3. Georges Kyriakou
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  4. Jean François Griveau
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  5. Dominique Le Lannou
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  6. Bernard Lobel
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Correspondence to Maroun Abi Moussa.

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Moussa, M.A., Guillé, F., Kyriakou, G. et al. Efficacité et innocuité du prélèvement percutané de sperme testiculaire dans la prise en charge de l’infertilité masculine. Androl. 13, 122–127 (2003). https://doi.org/10.1007/BF03034425

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  • DOI: https://doi.org/10.1007/BF03034425

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Basic and Clinical Andrology

ISSN: 2051-4190