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

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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

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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

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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

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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

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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.

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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

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Obrigado

Acesse http://

www.slideshare.net/sandroesteves

http://androfert.com.br/videos Esteves SC, Int Braz J Urol 2013

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