Masaki Dobashi

Conventional Versus Microdissection Testicular Sperm Extraction for Nonobstructive Azoospermia

PURPOSE We established a practical and safe strategy for testicular sperm extraction (TESE) in patients with nonobstructive azoospermia and compared conventional with microdissection TESE. MATERIALS AND METHODS In a retrospective comparative study 46 patients, including 22 with obstructive and 24 with nonobstructive azoospermia, underwent conventional TESE. Another 100 patients, including 26 with obstructive and 74 with nonobstructive azoospermia, underwent microdissection TESE. Conventional TESE was performed via 3 small 5 mm. incisions in the tunica albuginea. Microdissection TESE was performed by making a 3 to 4 cm. incision in the tunica albuginea under operating microscopy, avoiding the underlying testicular artery. Seminiferous tubules that appeared dilated and opaque were harvested. Sperm recovery rates were compared, as were complication rates assessed by ultrasonographic and endocrinological evaluations. RESULTS In obstructive azoospermia cases the sperm recovery rate was 100% for each procedure. In nonobstructive azoospermia cases sperm were recovered in 16.7% and 44.6% by conventional and microdissection TESE, respectively (p = 0.0271). In cases of histologically diagnosed maturation arrest the sperm recovery rate was 37.5% and 75%, respectively (p = 0.22585). In cases of the Sertoli-cell-only syndrome the sperm recovery rate was 6.3% and 33.9%, respectively (p = 0.0494). We identified dilated and opaque seminiferous tubules containing spermatozoa under operating microscopy in 22.2% of patients with maturation arrest and in 63.2% with the Sertoli-cell-only syndrome. The complication rate was significantly lower for microdissection than for conventional TESE. CONCLUSIONS In nonobstructive cases, especially those of the Sertoli-cell-only syndrome, microdissection TESE can effectively retrieve spermatozoa and minimize the risk of complications.

Distribution of type IV collagen subtypes in human testes and their association with spermatogenesis

OBJECTIVE To evaluate the expression of type IV collagen [alpha1(IV) to alpha6(IV)] in testes and the association with spermatogenesis. DESIGN Retrospective immunohistochemical study. SETTING Division of Urology, Department of Organs Therapeutics, Faculty of Medicine, in a university hospital. PATIENT(S) Testicular biopsy specimens were obtained from 24 patients with varicocele, 5 with Sertoli cell-only syndrome (SCO), and 5 normal volunteers. INTERVENTION(S) Collection of testicular tissue and blood and semen sampling. RESULT(S) Expression of type IV collagen subtypes assessed by immunohistochemistry and clinical parameters such as seminogram and hormonal findings. In normal testes, the alpha1(IV) chain was seen in the basement membrane (BM) of seminiferous tubules as strongly stained irregular, wavy double lines, and the alpha2(IV) chain was slightly detected, whereas other testes showed little staining. In patients with varicocele and Sertoli cell-only syndrome, the BM was thicker and alpha1(IV) and alpha2(IV) chains were stained more intensely in the BM of seminiferous tubules than in normal testes. The expression of alpha1(IV) chain, not alpha2(IV), significantly correlated positively with the BM thickness, and negatively with sperm concentration, tubular diameter, and Johnsen score. CONCLUSION(S) Overabundance of the alpha1(IV) chain is associated with increased BM thickness and possibly related to spermatogenic dysfunction.

INHIBITION OF STEROIDOGENESIS IN LEYDIG CELLS BY EXOGENOUS NITRIC OXIDE OCCURS INDEPENDENTLY OF STEROIDOGENIC ACUTE REGULATORY PROTEIN (StAR) MRNA

Nitric oxide (NO) plays multiple roles in the reproductive system. The authors studied the effect of NO on LH-stimulated steroidogenesis in primary cultures of rat Leydig cells, particularly seeking a link between inhibition of steroidogenesis and changes in expression of steroidogenic acute regulatory protein (StAR). Sodium nitroprusside (SNP), an NO generator, did not alter basal testosterone, but dosedependently reduced testosterone production in the Leydig cells stimulated by LH (100 ng/mL) at 3 h after addition of SNP. Induction of StAR mRNA transcripts could be detected as early as 1 h after the addition of LH, but no effect was detected of SNP on LH induction of StAR mRNA. StAR, then, is not affected in the inhibition by NO of LH-stimulated steroidogenesis in Leydig cells.

Hand-assisted laparoscopic radical nephrectomy using intraoperative ultrasonography for left renal cell carcinoma involving a level I renal vein tumor thrombus.

Abstract  This report concerns two male patients, 65 ( case 1 ) and 72 ( case 2 ) years old, with a left renal tumor involving a level I renal vein tumor thrombus, who underwent hand‐assisted laparoscopic radical nephrectomy using intraoperative ultrasonography. With the patient in the flank position, a midline supraumbilical hand port and two other ports were placed. Intraoperative ultrasonography identified the extent of the tumor thrombus. After hilar control, complete resection with intact removal was performed. Surgery lasted 305 min for case 1 and 237 min for case 2 , with respective estimated blood loss of 410 mL and 572 mL. No postoperative complications occurred. Pathological examination showed a clear cell carcinoma with a level I tumor thrombus and negative surgical margins. Because the ultrasound probe can be easily inserted and the specimen can be extracted safely and intact, hand‐assisted laparoscopic radical nephrectomy is practicable and effective for left renal cell carcinoma involving a level I renal vein tumor thrombus.

Adenoviral-mediated HGF expression inhibits germ cell apoptosis in rats with cryptorchidism.

Prior studies have shown that the hepatocyte growth factor (HGF), as known for its multiple biological effects, possibly regulates spermatogenesis or tubulogenesis in the testis. To clarify the effect of HGF on restoration of spermatogenesis, or testicular weight, we transferred the HGF gene into the testis of the rat experimental cryptorchid model.

SERUM INHIBIN PRO αC IN INFERTILE MEN

Specific assays have been developed for bioactive inhibin dimers, inhibin A and B, and inhibin f -subunit precursor pro f C. To better understand the role of serum inhibin pro f C in infertile men, the authors measured these forms of inhibin in sera from 39 infertile men and analyzed inhibin relationships with serum gonadotropins, testosterone, and estradiol. All subjects had oligozoospermia. Inhibin A levels were undetectable in all subjects. Inhibin B concentrations were 117 - 59 pg/mL. Inhibit B concentrations correlated negatively with serum FSH ( r =. 584, p <. 0001) and positively with sperm count ( p <. 01) and bilateral testicular volume ( r =. 607, p <. 0001). The concentration of pro f C was 556 - 236 pg/mL (normal range, 446 - 28). Inhibin pro f C showed no correlation with serum FSH, LH, testosterone, sperm concentration, and bilateral testicular volume. In addition, inhibin pro f C was not correlated with inhibin B. Pro f C is unlikely to be a useful marker for spermatogenesis in infertile men compared with inhibin B.

Sertoli cell number in testes of azoospermic men: trends in biopsy specimens.

The general male population has shown a long-term decline in sperm count. Induced hormonal imbalance can produce adverse reproductive effects in men, especially decreases in sperm count. One suggested cause for a decreased sperm count is a reduction in the number of Sertoli cells. The authors assessed numbers of Sertoli cells in testicular biopsy specimens obtained from azoospermic men between 1989 and 1999. The number of Sertoli cells per tubular area or circumference did not vary by year of biopsy among the tissue samples during this 10-year period. Patient age, taken as a measure of exposure duration to hypothesized abnormal hormonal environment, did not affect the number of Sertoli cells. Since no reduction in the number of Sertoli cells was observed, other pathogenic factors may be the cause of long-term decreases in sperm count.