Cargando…
The risk of TESE-induced hypogonadism: a systematic review and meta-analysis
BACKGROUND: Testicular sperm extraction (TESE) is a surgical procedure to retrieve spermatozoa from the testes of men with azoospermia to help them achieve biological parenthood. Although effective, the surgical procedure is not without complications and haematoma, devascularization, inflammation an...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2018
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016714/ https://www.ncbi.nlm.nih.gov/pubmed/29726895 http://dx.doi.org/10.1093/humupd/dmy015 |
_version_ | 1783334608487579648 |
---|---|
author | Eliveld, Jitske van Wely, Madelon Meißner, Andreas Repping, Sjoerd van der Veen, Fulco van Pelt, Ans M M |
author_facet | Eliveld, Jitske van Wely, Madelon Meißner, Andreas Repping, Sjoerd van der Veen, Fulco van Pelt, Ans M M |
author_sort | Eliveld, Jitske |
collection | PubMed |
description | BACKGROUND: Testicular sperm extraction (TESE) is a surgical procedure to retrieve spermatozoa from the testes of men with azoospermia to help them achieve biological parenthood. Although effective, the surgical procedure is not without complications and haematoma, devascularization, inflammation and a decrease in testosterone levels have been described as such. The prevalence and duration of hypogonadism and associated symptoms after TESE have not been studied systematically. OBJECTIVE AND RATIONALE: In this systematic review we addressed the following research questions: Are serum testosterone levels decreased after TESE and, if so, do these levels recover over time? What is the prevalence of symptoms and signs related to hypogonadism after TESE and are they related to testosterone levels? SEARCH METHODS: We searched the databases Pubmed and Embase from 1 January 1993 to 26 June 2017. We combined subject headings with terms in title and/or abstract for participants, intervention and outcomes. We included all studies that reported on TESE, regardless of the specific technique used, that measured testosterone and/or LH, and/or had information on signs or symptoms related to hypogonadism as defined by hypogonadism guidelines. An additional inclusion criterion was that studies described these measurements both before and after TESE. The quality of the included studies was assessed using the Risk Of Bias In Non-randomized Studies—of Interventions tool. OUTCOMES: We identified 15 studies reporting on total testosterone levels of which five studies also reported on testicular volume and one study on erectile dysfunction. Men with Klinefelter syndrome and men with non-obstructive azoospermia had the strongest decrease in total testosterone levels 6 months after TESE, with a mean decrease of 4.1 and 2.7 nmol/l, respectively, which recovered again to baseline levels 26 and 18 months after TESE, respectively. At 6 months after TESE, some studies reported serum total testosterone concentrations below a cut-off value of 12 nmol/l, where symptoms and signs related to hypogonadism may appear. Furthermore, an increased prevalence of erectile dysfunction related to decreased total testosterone levels 6 months after TESE was reported. Also, in some men a decrease in testicular volume was reported. However, it is not clear if this is related to low testosterone levels. WIDER IMPLICATIONS: The transient, but statistically significant, decrease in total testosterone levels indicates that men are at risk of developing a temporary hypogonadism after TESE, but there is insufficient evidence for whether patients actually experience clinical symptoms in case of decreased serum testosterone levels. To be able to properly counsel TESE patients, more large-scale monitoring on signs and symptoms of hypogonadism, in combination with testosterone measurements, needs to be performed in men undergoing TESE. |
format | Online Article Text |
id | pubmed-6016714 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-60167142018-07-05 The risk of TESE-induced hypogonadism: a systematic review and meta-analysis Eliveld, Jitske van Wely, Madelon Meißner, Andreas Repping, Sjoerd van der Veen, Fulco van Pelt, Ans M M Hum Reprod Update Review BACKGROUND: Testicular sperm extraction (TESE) is a surgical procedure to retrieve spermatozoa from the testes of men with azoospermia to help them achieve biological parenthood. Although effective, the surgical procedure is not without complications and haematoma, devascularization, inflammation and a decrease in testosterone levels have been described as such. The prevalence and duration of hypogonadism and associated symptoms after TESE have not been studied systematically. OBJECTIVE AND RATIONALE: In this systematic review we addressed the following research questions: Are serum testosterone levels decreased after TESE and, if so, do these levels recover over time? What is the prevalence of symptoms and signs related to hypogonadism after TESE and are they related to testosterone levels? SEARCH METHODS: We searched the databases Pubmed and Embase from 1 January 1993 to 26 June 2017. We combined subject headings with terms in title and/or abstract for participants, intervention and outcomes. We included all studies that reported on TESE, regardless of the specific technique used, that measured testosterone and/or LH, and/or had information on signs or symptoms related to hypogonadism as defined by hypogonadism guidelines. An additional inclusion criterion was that studies described these measurements both before and after TESE. The quality of the included studies was assessed using the Risk Of Bias In Non-randomized Studies—of Interventions tool. OUTCOMES: We identified 15 studies reporting on total testosterone levels of which five studies also reported on testicular volume and one study on erectile dysfunction. Men with Klinefelter syndrome and men with non-obstructive azoospermia had the strongest decrease in total testosterone levels 6 months after TESE, with a mean decrease of 4.1 and 2.7 nmol/l, respectively, which recovered again to baseline levels 26 and 18 months after TESE, respectively. At 6 months after TESE, some studies reported serum total testosterone concentrations below a cut-off value of 12 nmol/l, where symptoms and signs related to hypogonadism may appear. Furthermore, an increased prevalence of erectile dysfunction related to decreased total testosterone levels 6 months after TESE was reported. Also, in some men a decrease in testicular volume was reported. However, it is not clear if this is related to low testosterone levels. WIDER IMPLICATIONS: The transient, but statistically significant, decrease in total testosterone levels indicates that men are at risk of developing a temporary hypogonadism after TESE, but there is insufficient evidence for whether patients actually experience clinical symptoms in case of decreased serum testosterone levels. To be able to properly counsel TESE patients, more large-scale monitoring on signs and symptoms of hypogonadism, in combination with testosterone measurements, needs to be performed in men undergoing TESE. Oxford University Press 2018-07 2018-05-03 /pmc/articles/PMC6016714/ /pubmed/29726895 http://dx.doi.org/10.1093/humupd/dmy015 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Review Eliveld, Jitske van Wely, Madelon Meißner, Andreas Repping, Sjoerd van der Veen, Fulco van Pelt, Ans M M The risk of TESE-induced hypogonadism: a systematic review and meta-analysis |
title | The risk of TESE-induced hypogonadism: a systematic review and meta-analysis |
title_full | The risk of TESE-induced hypogonadism: a systematic review and meta-analysis |
title_fullStr | The risk of TESE-induced hypogonadism: a systematic review and meta-analysis |
title_full_unstemmed | The risk of TESE-induced hypogonadism: a systematic review and meta-analysis |
title_short | The risk of TESE-induced hypogonadism: a systematic review and meta-analysis |
title_sort | risk of tese-induced hypogonadism: a systematic review and meta-analysis |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016714/ https://www.ncbi.nlm.nih.gov/pubmed/29726895 http://dx.doi.org/10.1093/humupd/dmy015 |
work_keys_str_mv | AT eliveldjitske theriskofteseinducedhypogonadismasystematicreviewandmetaanalysis AT vanwelymadelon theriskofteseinducedhypogonadismasystematicreviewandmetaanalysis AT meißnerandreas theriskofteseinducedhypogonadismasystematicreviewandmetaanalysis AT reppingsjoerd theriskofteseinducedhypogonadismasystematicreviewandmetaanalysis AT vanderveenfulco theriskofteseinducedhypogonadismasystematicreviewandmetaanalysis AT vanpeltansmm theriskofteseinducedhypogonadismasystematicreviewandmetaanalysis AT eliveldjitske riskofteseinducedhypogonadismasystematicreviewandmetaanalysis AT vanwelymadelon riskofteseinducedhypogonadismasystematicreviewandmetaanalysis AT meißnerandreas riskofteseinducedhypogonadismasystematicreviewandmetaanalysis AT reppingsjoerd riskofteseinducedhypogonadismasystematicreviewandmetaanalysis AT vanderveenfulco riskofteseinducedhypogonadismasystematicreviewandmetaanalysis AT vanpeltansmm riskofteseinducedhypogonadismasystematicreviewandmetaanalysis |