ObjectiveTo determine the success rate of oncological microdissection testicular sperm extraction (onco‐microTESE) in patients with testicular cancer (TC) with azoospermia and severe oligoasthenoteratozoospermia (OAT; <1 million/mL sperm) and to explore any factors that may predict success.Patients and MethodsCase series of outcomes from all consecutive patients (42 testes in 38 patients) that presented or were referred to a single specialist tertiary referral centre for fertility management in the context of TC with severe OAT or azoospermia between August 2015 and August 2022. Biochemical, radiological, and histological parameters were collected for all patients. All patients underwent onco‐microTESE (simultaneous radical inguinal orchidectomy with ex vivo microTESE of the affected testis). Those with unsuccessful surgical sperm retrieval (SSR) from the affected testis underwent contemporaneous contralateral microTESE, if no contraindication was present. The primary outcome was successful SSR from the affected testicle sufficient for assisted reproductive techniques. Secondary outcomes included contralateral microTESE success, the time from referral to procedure, and the total successful fertility preservation rate.ResultsInitial onco‐microTESE was successful in 19 of 31 patients (61%) with azoospermia. Contralateral microTESE was successful in a further two of eight patients with azoospermia with failed onco‐microTESE. Overall, 22/31 patients with azoospermia (71%) had successful fertility preservation in this series. In addition, six of seven patients with severe OAT had further sperm harvested by onco‐microTESE to maximise their fertility preservation. All surgery was performed within median (interquartile range) of 7 (5–13) days from presentation.ConclusionsOnco‐microTESE represents an effective method of fertility preservation for sub‐fertile patients with TC without delaying oncological treatment. Knowledge of the fertility status at first presentation is essential to allow for such additional options for optimal fertility preservation in TC.

中文翻译：

---

肿瘤显微解剖睾丸精子提取 （Onco-microTESE） 对睾丸癌无精子症或严重少弱精子症患者生育能力保存的结果


目的确定睾丸癌 （TC） 伴无精子症和严重少弱精子症 （OAT;<1 百万/mL 精子） 患者肿瘤显微解剖睾丸精子提取 （onco-microTESE） 的成功率，并探讨任何可能预测成功的因素。患者和方法2015 年 8 月至 2022 年 8 月期间，在 TC 伴有严重 OAT 或无精子症的情况下，所有连续患者 （38 例患者中 42 个睾丸） 出现或被转诊到单一专科三级转诊中心进行生育管理的病例系列结果。收集所有患者的生化、放射学和组织学参数。所有患者都接受了 onco-microTESE （同时根治性腹股沟睾丸切除术与受影响睾丸的离体 microTESE）。那些从受影响的睾丸手术取精 （SSR） 不成功的患者，如果不存在禁忌症，则同时接受对侧 microTESE。主要结局是受影响睾丸的成功 SSR 足以用于辅助生殖技术。次要结局包括对侧 microTESE 成功率、从转诊到手术的时间以及总成功保留生育率。结果初始 onco-microTESE 在 31 例无精子症患者中有 19 例 （61%） 成功。对侧 microTESE 在 8 例 onco-microTESE 失败的无精子症患者中有 2 例成功。总体而言，22/31 无精子症患者 （71%） 在该系列中成功保留了生育能力。此外，7 名严重 OAT 患者中有 6 名通过 onco-microTESE 进一步采集精子，以最大限度地保留他们的生育能力。所有手术均在就诊后 7 （5-13） 天的中位（四分位距）内进行。结论Onco‐microTESE 代表了 TC 低生育力患者在不延迟肿瘤治疗的情况下保持生育能力的有效方法。在首次就诊时了解生育状态对于在 TC 中实现最佳生育力保存的此类额外选择至关重要。