A clinical trial on the consistency of bilateral testicular tissue histopathology and Johnsen score: single side or bilateral side biopsy?
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Wen-Hao Tang1,*, Shan-Jie Zhou2,*, Shi-De Song3, Hui-Ying He4, Han Wu1, Zhe Zhang1, Yu-Zhuo Yang1, Hong-Liang Zhang5, Jia-Ming Mao5, De-Feng Liu5, Lian-Ming Zhao1, Hao-Cheng Lin1, Kai Hong1, Lu-Lin Ma1, Xin-Jie Zhuang5 and Hui Jiang1
1Department of Urology, Peking University Third Hospital, Beijing 100191, China
2Reproductive Medicine Centre, Peking University International Hospital, Beijing 102206, China
3Department of Urology, Rizhao People’s Hospital, Rizhao, Shandong 276826, China
4Department of Pathology, Peking University, Health Science Center, Beijing 100191, China
5Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
*These authors have contributed equally to this work
Xin-Jie Zhuang, email: [email protected]
Hui Jiang, email: [email protected]
Keywords: azoospermia; nonobstructive; male infertility; biopsy; pathology
Received: July 03, 2017 Accepted: March 01, 2018 Published: May 08, 2018
To evaluate and compare left and right testicular tissue histopathology and Johnsen score, and to investigate the necessity for bilateral testicular biopsy. We recruited180 patients with non-obstructiveazoospermia (NOA) on testicular biopsy who had undergonetesticular sperm aspiration (TESA). Pathological sections of testicular tissue were diagnosed by specially-assigned doctors, who evaluated pathological findings, determined the Johnsen score and confirmed for the presence or absence of sperm. Sperm positive rates for left and right testicular histopathology were 55.0% and 51.7% respectively, and the proportion of Johnsen scores≥8 for left and right testes were 53.3% and 50.0%, respectively. Cohen kappa values revealed that the identification of sperm in bilateral testicular samples was not consistent and was related to random effects; Optimized cut-off value for bilateral testicular volume was 11ml (Johnsen score ≥8), and optimized cut-off values of E2 on left and right testes were 144.5pmol/L and 133.5 pmol/L (Johnsen score≤7). However, age, serum prolactin (PRL), follicle stimulating hormone (FSH), luteinizing hormone (LH) and total testosterone (TT) levels were not accurate predictors for the existence of testicular sperm. There was nostatistical significance between left and right testicular histopathology in terms of sperm positive rates or Johnsen score; the Johnsen score were caused entirely by random effects and a score from one side could not represent the other side. Therefore, we recommend that both testes need to undergo surgery when NOA patients undergo testicular biopsy or sperm retrieval.
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