Zusammenfassung
In den Richtlinien der „European Association of Urology“ (EAU) sind folgende Indikationen für eine Hodenbiopsie festgelegt:
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Eine therapeutische Hodenbiopsie zur testikulären Spermienextraktion (TESE) ist im Falle einer obstruktiven Azoospermie (OA) bei normalen Hodenvolumina und FSH-Wert (<7 IU/l) sowie niedrigen Markern für Nebenhoden (α-Glukosidase, l-Carnitin) oder Samenblase (Fruktose) ohne Chance auf eine chirurgische Rekonstruktion indiziert, z.B. bei kongenitaler bilateraler Aplasie der Samenleiter. Als Alternative kann eine mikrochirurgische epididymale Spermienaspiration (MESA) durchgeführt werden. Im Falle einer mikrochirurgischen Refertilisierung (Vaso-Vasostomie, Vaso-Tubulostomie) nach Vasektomie hilft eine diagnostische Hodenbiopsie, einen Spermatogeneseschaden auszuschließen. In beiden Fällen ermöglicht die Kryokonservierung die Verwendung von durch TESE oder MESA gewonnenen Spermien für die intrazytoplasmatische Spermieninjektion (ICSI), wenn eine mikrochirurgische Refertilisierung nicht möglich oder nicht erfolgreich ist.
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Eine therapeutische Biopsie ist indiziert im Falle einer nichtobstruktiven Azoospermie (NOA), entweder normogonadotrop (FSH <7 IU/l) oder hypergonatrop (FSH >7 IU/l). Eine hypergonadotrope Azoospermie weist auf eine fokal geschädigte Spermatogenese, z.B. assoziiert mit einem fokalen oder totalen Sertoli-Cell-Only-Syndrome (SCO), hin. In diesen Fällen ist eine TESE der fokalen Areale mit einer zumindest qualitativ intakten Spermatogenese in Kombination mit ICSI und IVF die einzige rationale Therapie (Bergmann et al. 1994; Zitzmann et al. 2006). Das Hodengewebe wird für eine spätere Verwendung mit Techniken der assistierten Reproduktion immer kryokonserviert (EAU-Richtlinien 2007).
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Eine diagnostische Hodenbiopsie ist indiziert zum Ausschluss einer präinvasiven testikulären intraepithelialen Neoplasie (TIN) im Falle eines inhomogenen ultrasonographischen Befundes (Mikrolithiasis) (von Eckardstein et al. 2001; de Gouveia Brazao et al. 2004). Die Doppelbiopsie des kontralateralen Hodens ist indiziert bei klinisch manifestem Keimzelltumor, da eine kontralaterale TIN bei Patienten mit einem Hodentumor eine Prävalenz von 5–6% hat (Kliesch et al. 2003; Dieckmann et al. 2007). Außerdem findet sich bei 2–4% aller Männer mit einem adulten Kryptorchismus eine TIN (Rϕrth et al. 2000).
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Eine therapeutische Hodenbiopsie ist ebenfalls indiziert bei Patienten mit Klinefelter-Syndrom, die zumindest zu einem kleinen Anteil eine fokale Spermatogenese aufweisen, die eine Therapie mit TESE und ICSI ermöglicht (Lanfranco et al. 2004; Schiff et al. 2005).
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Bergmann, M., Kliesch, S. (2009). Biopsie und Histologie der Hoden. In: Nieschlag, E., Behre, H.M., Nieschlag, S. (eds) Andrologie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-92963-5_11
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