An integrative prediction model of successful sperm retrieval for men with non-obstructive azoospermia

Un modelo predictivo integral para el éxito de la recuperación de espermatozoides en hombres con azoospermia no obstructiva

Microdissection testicular sperm extraction (micro-TESE) is an efficient method for obtaining spermatozoa from patients with non-obstructive azoospermia, but the overall success rate of this surgery is only approximately one-third. This study aimed to construct an integrative prediction model for andrologists to assess the preoperative success retrieval rate. A total of 217 patients diagnosed with non-obstructive azoospermia at the First Affiliated Hospital of Nanjing Medical University were included, in whom sperm was successfully retrieved in 71 patients. We retrospectively analyzed their clinical characteristics and pathological features. Single factor analysis and logistic regression analysis were utilized to validate the predictive performance, and the area under the curve (AUC) analysis was conducted to further assess the clinical diagnostic value of the model. The results showed that a history of Klinefelter syndrome or cryptorchidism, FSH (Follicle Stimulating Hormone) levels, and testicular pathology contributed differently to the nomogram prediction model. Relatively normal FSH levels, a history of Klinefelter syndrome or cryptorchidism, and favorable testicular pathological types were assigned higher scores, with higher scores often accompanying a preferable success rate of sperm retrieval. The integrated model showed good prediction performance, with an AUC (Area Under the Curve) of 0.781 (95%CI (confidence interval) 0.713–0.849). Overall, our integrative model demonstrates excellent prediction performance and may assist andrologists in balancing the benefits of surgery preoperatively.

Resumen

La microanatomía de la extracción de espermatozoides testiculares (microtese) es un método eficaz para ayudar a los andrólogos a obtener espermatozoides de pacientes con azoospermia no obstructiva. Sin embargo, la tasa general de éxito de la cirugía es de solo alrededor de un tercio. Nuestro estudio tiene como objetivo construir un modelo predictivo integral para andrólogos para evaluar la tasa de éxito preoperatorio. Nuestro estudio incluyó a un total de 217 pacientes diagnosticados con azoospermia no obstructiva en el Primer Hospital Afiliado de la Universidad Médica de nanjing, de los cuales 71 recuperaron con éxito espermatozoides. Analizamos retrospectivamente sus características clínicas y patológicas. posteriormente se utilizó un análisis univariado y un análisis de regresión logística para verificar su rendimiento predictivo. Se realizó un análisis de área bajo curva para evaluar más a fondo el valor diagnóstico clínico del modelo. Encontramos que la historia clínica del síndrome de Klinefelter o criptorquídeos, la FSH (Hormona estimulante del folículo) y la patología testicular contribuyen de manera diferente al modelo predictivo de nomograma. Los niveles relativamente normales de FSH, los antecedentes de síndrome de Klinefelter o criptorquidismo y los buenos tipos patológicos testiculares obtuvieron puntajes más altos. Las puntuaciones más altas a menudo van acompañadas de una mayor tasa de éxito en la recuperación de espermatozoides. El modelo combinado mostró un buen rendimiento predictivo, con un AUC (Área bajo curva) de 0.781 (ic (Intervalo de confianza) 95% 0.713–0.849). Nuestro modelo integral muestra un excelente rendimiento predictivo que puede ayudar a los andrólogos a equilibrar los beneficios de la cirugía preoperatoria.

Non-obstructive azoospermia; Micro-TESE; Prediction model

Palabras Clave

Azoospermia no obstructiva; Microtese; Modelo predictivo

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