ABSTRACT
<p><b>Objective</b>To investigate the value of micro- dissection testicular sperm extraction (micro-TESE) in the treatment of non-obstructive azoospermia (NOA) in patients with the history of secondary testicular injury.</p><p><b>METHODS</b>Totally, 121 NOA patients with the history of secondary testicular injury underwent micro-TESE in our hospital from September 2014 to December 2017. We analyzed the correlation of the sperm retrieval rate with the causes of testicular injury and compared the outcomes of the ICSI cycles with the sperm retrieved from the NOA males by micro-TESE (the micro-TESE group) and those with the sperm ejaculated from severe oligospermia patients (sperm concentration <1×10⁶/ml, the ejaculate group). Comparisons were also made between the two groups in the female age, two-pronucleus (2PN) fertilization rate, transferrable embryos on day 3 (D3), D3 high- quality embryos, D14 blood HCG positive rate, embryo implantation rate, and clinical pregnancy rate.</p><p><b>RESULTS</b>Testicular sperm were successfully retrieved by micro-TESE in 86.0% of the patients (104/121), of whom 98.4% had the history of orchitis, 75.5% had been treated surgically for cryptorchidism, and 63.6% had received chemo- or radiotherapy. No statistically significant differences were observed between the micro-TESE and ejaculate groups in the 2PN fertilization rate (59.4% vs 69.3%, P > 0.05), D14 blood HCG positive rate (44.6% vs 57.9%, P > 0.05), embryo implantation rate (31.8 %% vs 32.6%, P > 0.05) and clinical pregnancy rate (41.5% vs 48.7%, P > 0.05). However, the rate D3 transferrable embryos was significantly lower in the micro-TESE than in the ejaculate group (40.5% vs 52.2%,P < 0.05), and so was that of D3 high-quality embryos (32.5% vs 42.1%, P < 0.05).</p><p><b>CONCLUSIONS</b>Micro-TESE can be applied as the first choice for NOA patients with the history of secondary testicular injury, but more effective strategies are to be explored for the improvement of ICSI outcomes with the sperm retrieved by micro- TESE.</p>
ABSTRACT
<p><b>BACKGROUND</b>Intraoperative ultrasound (IOUS) has been increasingly used as a guiding tool during neurosurgical procedures. In this study, we aimed to evaluate the potential application of intraoperative ultrasound assisted surgery in the resection of small, deep-seated, or ill-defined lesions.</p><p><b>METHODS</b>Eighty-six consecutive patients with small, deep-seated, or ill-defined intracerebral lesions were studied prospectively. An improved intraoperative imaging technique and surgical setup were practiced during the surgery. IOUS was performed in three orthogonal imaging planes (horizontal, coronal and sagittal).</p><p><b>RESULTS</b>Histopathological diagnoses of these 86 cases included cavernomas, metastases, hemangioblastomas, gliomas, and radiation necrosis. Forty-seven of the 86 lesions (54.7%) were small and deep-seated, 34/86 (39.5%) were ill-defined, and 5/86 (5.8%) were small, deep-seated, and ill-defined. Sonograms in the horizontal plane were obtained in all 86 cases. Sonograms in the sagittal plane and in the coronal plane were obtained only in 52 cases and in 46 cases, respectively, due to technical limitation. In 13 cases, sonograms in all three orthogonal planes were available. All lesions were successfully identified and localized by IOUS. Total resection was performed in 67 lesions (77.9%) and partial resection was performed in 19 lesions (22.1%).</p><p><b>CONCLUSIONS</b>We propose IOUS to be performed in three orthogonal planes when surgery is planned for small, deep-seated, or ill-defined brain lesions. By applying this simple, improved technique, surgeons can perform resection of these lesions precisely.</p>