Post on 11-Apr-2017
MESA, TESE, MicroTESE
Sandro C. EstevesDiretor Médico e Científico, ANDROFERT
Campinas, São Paulo
XXXV Congresso Brasileiro de Urologia Rio de Janeiro, Novembro 2015 – C37
Técnicas de Captação de Espermatozoides para
Reprodução Assistida (ICSI)
Esteves et al. Sperm Retrieval Techniques. Int Braz J Urol 2011; 37: 570-83
Acrônimo Técnica
MESA Microsurgical Epididymal Sperm Aspiration
TESE Testicular Sperm Extraction
Micro-TESE
Microdissection Testicular Sperm Extraction
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTIONS ESTEVES, 22015
ANDROFERT
Azoospermia Obstrutiva
Technique AcronymPercutaneous Epididymal Sperm Aspiration PESA
Microsurgical Epididymal Sperm Aspiration MESA
Testicular Sperm Aspiration TESA
Esteves & Agarwal. Sperm Retrieval Techniques. Cambridge University Press, 2011
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTIONS ESTEVES, 32015
ANDROFERT
Microsurgical Epididymal Sperm Aspiration (MESA)
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTIONS ESTEVES, 52015
ANDROFERTCortesia Dr. Marcello Cocuzza
Esteves SC, Int Braz J Urol 2015; 41:817-8.
Available at: www.brazjurol.com.br/videos/july_august_2015/Esteves_817_818video.htm
MESA vs PESAMESA PESA
Efetividade (Sptz +)
~100% ~100%
Eficiência (No. Sptz)
+++ ++
Criopreservação ~100% casos
1/3 casos
Custo-efetividade
NA NA
Complexidade +++ +Complicações ++ +
(8/146=5.5%)*Repetição Sim SimEfetividade ICSI ~40% NV/TE
Miyaoka & Esteves. Clinics 2013; 68 Suppl 1: 111-9.*Esteves et al. J Urol. 2013; 189(1): 232-7
100% 96.6% 96.3%
CBAVD Vasectomy Post-infection
OBSTRUCTIVE AZOOSPERMIA
Successful Retrievals
PESA alonePESA + rescue TESA
Esteves et al. J Urol. 2013; 189(1): 232-7
146 patients
Sperm retrieval in CBAVD
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTIONS ESTEVES, 82015
ANDROFERT
78.1%
~100%
Azoospermia Não-obstrutiva
Técnica Acrônimo Tx sucesso
Testicular Sperm Aspiration TESA 15-50%Testicular Sperm Extraction TESE 20-60%Microsurgical Testicular Sperm Extraction Micro-TESE 40-67%
Esteves & Agarwal. Sperm Retrieval Techniques. Cambridge University Press, 2011
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTIONS ESTEVES, 102015
ANDROFERT
Micro-TESE vs TESE: Efetividade
Overa
ll
Hypos
permat
ogen
esis
Matura
tion A
rrest
Serto
li-ce
ll Only
45%93%
64%20%25%
64%
9% 6%
Sperm Retrieval Success RatesMicro-TESE single-biopsy TESE
Controlled series (N=60)
Histology categoriespairwise comparisons:
p<0.0001
MethodP=0.000
5
Verza Jr & Esteves. Fertil Steril 2011; 96 (Suppl.): S53
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTIONS ESTEVES, 132015
ANDROFERT
Tissue removed (mg)Conventional TESE Micro-TESE P-value
65 ± 25 8.9 ± 2.5 <0.01Conventional TESE Micro-TESE
Esteves & Varghese J Reprod Sci 2012; 5: 233-43.
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTIONS ESTEVES, 142015
ANDROFERT
Micro-TESE vs TESE: Eficiência
41.4 47 43.3 20100 64 61 34.2P<0.01
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTIONS ESTEVES, 152015
ANDROFERT
Obrigado
Acesse http://
www.slideshare.net/sandroesteves
http://androfert.com.br/videos Esteves SC, Int Braz J Urol 2013
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTIONS ESTEVES, 172015
ANDROFERT