Open epididymal sperm aspiration (OESA): 微小傷口MESA

Open epididymal sperm aspiration (OESA) 屬於微小傷口之MESA，副睪附近切一道<1cm刀口

找到副睪 以18號針頭抽取
若無法找到精蟲，直接以同一刀口施行睪丸取精(TESE)
施行ICSI後，OESA懷孕率較TESE為高 (27 vs 7%)

http://www.arch-espanoles-de-urologia.es/apartados/sumarios/popup.php?&ano=2006&id=59-03-21


Arch Esp Urol. 2006 Apr;59(3):313-6.

Open epididymal sperm aspiration (OESA): minimally invasive surgical technique for sperm retrieval.

Lania C, Grasso M, Fortuna F, De Santis L, Fusi F.

Source

Department of Urology, Institute H. S. Raffaele, Milan, Italy.

Abstract

OBJECTIVES:

Male infertility caused by irreparable obstructive azoospermia is widely treated with MESA (Microsurgical Epididymal Sperm Aspiration) or TESE (Testicular Sperm Extraction) or PESA (Percutaneous Epididymal Sperm Aspiration) followed by an Intracytoplasmatic Spermatozoa Injection (ICSI). For each procedures are claimed advantages and disadvantages. Aim of this work is to describe our technique (OESA) for sperm retrieval reporting the results.

METHODS:

From 1998 to 2003 153 sperm retrieval procedures in azoospermic patients were performed. The technique consists in a small (1 cm.) surgical incision of scrotal wall under local or spinal anaesthesia. After inspecting the intrascrotal component to record the status of the epididymis and of the testicle, epididymal sperm aspiration was performed in the most appropriate site with 18 gauge needle. The aspirated spermatozoa were used immediately after aspiration not being permitted in our Institute cryopreservation. When no sperms were found TESE was performed.

RESULTS:

In 78 cases aspiration from epididymis was successful (OESA). In the other patients (75) TESE was performed. Higher count of spermatozoa were retrieved in all cases of OESA. Pregnancy rate was 26.6% for OESA and 6.4% for TESE. No complications occurred.

CONCLUSIONS:

This technique is very simple and easy allowing to obtain the advantages of microsurgical techniques (mainly choice of the most appropriate site of aspiration and immediate haemostasis if needed) with minimal invasivity (avoiding epididymal surgical incision). Moreover if OESA does not allow sperm extraction is possible to perform immediately TESE.