OBJECTIVE To explore predictors of successful sperm retrieval (SR) and to identify potentially suitable candidates for testicular sperm aspiration (TESA), a more straightforward, less traumatic, and less costly procedure than open surgical SR methods. DESIGN Retrospective chart review. SETTING Academic tertiary medical center. PATIENTS A total of 297 patients with nonobstructive azoospermia. INTERVENTIONS All patients underwent full clinical evaluation before undergoing a staged SR procedure, starting with TESA and proceeding to microsurgical testicular sperm extraction (microTESE). Predictors of positive SR with TESA were selected using the least absolute shrinkage and selection operator (LASSO) regression analysis using k-fold cross-validation. The obtained regression coefficients were used to create a predictive model, and a receiver operating characteristic (ROC) curve was obtained to express its predictive ability. Cut-off values for each significant predictor were also identified using ROC analysis. MAIN OUTCOME MEASURE(S) Development of a prediction model for positive SR with TESA. RESULTS Overall, a positive SR was observed in 23.6% of patients undergoing TESA. Average testis size (P = .017) and serum follicle-stimulating hormone (FSH) level (P < .001) were the significant predictors of positive SR identified by LASSO regression analysis. The predictive model had an AUC of 0.742 with a sensitivity of 73.9% and specificity of 69.9%. Patients presenting with an average testis size >7.75 mL and serum FSH level <8.5 IU/L had a TESA-positive SR of 43%. CONCLUSIONS TESA may be a suitable alternative to microTESE in selected nonobstructive azoospermia patients presenting with an average testis size >7.75 mL and serum FSH level <8.5 IU/L.

中文翻译：

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非梗阻性无精子症患者睾丸精子抽吸成功率的预测模型

目的 探索成功取精 (SR) 的预测因素并确定睾丸精子抽吸 (TESA) 的潜在合适候选者，TESA 是一种比开放式手术 SR 方法更直接、创伤更小且成本更低的手术。设计回顾性图表审查。设置学术三级医疗中心。患者 共有 297 名非梗阻性无精子症患者。干预 所有患者在进行分期 SR 手术之前都接受了全面的临床评估，从 TESA 开始并进行显微手术睾丸精子提取 (microTESE)。使用最小绝对收缩和选择算子 (LASSO) 回归分析使用 k 折交叉验证来选择 TESA 阳性 SR 的预测因子。获得的回归系数用于创建预测模型，并获得受试者工作特征（ROC）曲线来表达其预测能力。还使用 ROC 分析确定了每个重要预测因子的临界值。主要结果测量 使用 TESA 开发正 SR 预测模型。结果 总体而言，在 23.6% 接受 TESA 的患者中观察到阳性 SR。平均睾丸大小 (P = .017) 和血清促卵泡激素 (FSH) 水平 (P < .001) 是通过 LASSO 回归分析确定的阳性 SR 的重要预测因素。该预测模型的 AUC 为 0.742，敏感性为 73.9%，特异性为 69.9%。平均睾丸大小 >7.75 mL 和血清 FSH 水平 <8.5 IU/L 的患者的 TESA 阳性 SR 为 43%。