Abstract
BackgroundThe aim of this study is to assess the value of contrast-enhanced ultrasound (CEUS) as a new non-invasive approach to locate the testicular area in which spermatogenesis is most likely to be found in non-obstructive azoospermic testes and to evaluate the accuracy of CEUS as a predictor of successful sperm retrieval.MethodsCEUS was performed in 120 nonobstructive azoospermia (NOA) patients. Microdissection testicular sperm extraction (M-TESE) was performed on the best and poorest perfusion areas selected by CEUS and on conventional areas.ResultsIn the 187 testicles that underwent M-TESE, the sperm retrieval rates (SRRs) in the best perfusion area and poorest perfusion area over the maximal longitudinal section and conventional area were 63.1, 34.7 and 47.1%. According to receiver operating characteristic (ROC) analysis, the arrival times (AT) ≤27 s, time-to-peak intensity (TTP) ≤45 s, and peak intensity (PI) ≥11 dB were the best predictors of positive sperm retrieval. The location of the best perfusion area was able to guide M-TESE to improve the success rates.ConclusionsTesticle CEUS is suggested to be performed in all patients with NOA. If AT≤27 s, TTP ≤ 45 s or PI≥11 dB are found in the best perfusion area, M-TESE is strongly recommended.
Highlights
The aim of this study is to assess the value of contrast-enhanced ultrasound (CEUS) as a new non-invasive approach to locate the testicular area in which spermatogenesis is most likely to be found in non-obstructive azoospermic testes and to evaluate the accuracy of CEUS as a predictor of successful sperm retrieval
peak intensity (PI) and The PI of the whole testicle (PIT) had a positive correlation with the Johnson score (P < 0.006; P < 0.031)
The high-density microvasculature greatly contributed to the high blood testicular perfusion, which was correlated with focal spermatogenesis [8, 9]
Summary
The aim of this study is to assess the value of contrast-enhanced ultrasound (CEUS) as a new non-invasive approach to locate the testicular area in which spermatogenesis is most likely to be found in non-obstructive azoospermic testes and to evaluate the accuracy of CEUS as a predictor of successful sperm retrieval. Testicular sperm extraction has been improved by the guidance of Doppler ultrasound in several studies, but Doppler ultrasound could not precisely localize seminiferous tubules containing sperm [2, 8, 10,11,12,13] because it was not able to show the testicle microvasculature. The microvasculature within the testicle was depicted by contrast enhanced ultrasound (CEUS), and spermatozoa residuals were most likely to be found in hyperperfused
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