Ukukhipha isidoda emasendeni ngenxa ye-azoospermia

Ukukhipha isidoda emasendeni, noma i-TESE, kuwuhlinzo lokukhipha isidoda ngqo emasendeni. Isidoda esikhipha ngqo emasendeni sisebenzisa kamuva ku-In Vitro Fertilization (IVF) [1].

Le ndlela iyasiza ikakhulukazi emibhangqwaneni ezama ukukhulelwa kodwa ebhekene nezinselelo zokungazali kowesilisa. Lolu hlinzo lusebenza kahle emadodeni ane-azoospermia, isimo lapho kuba nezidoda ezimbalwa kakhulu noma kungabikho nhlobo esidodeni esikhishwayo [2].

Kulesi sihloko, sizoxoxa ngezindlela ezahlukene zokukhipha izidoda emasendeni. Sizophinde sibheke nokuthi i-TESE isebenza kangakanani emadodeni angazali.

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Iyini I-Testicular Sperm Extraction (TESE)?

Njengoba igama lisho, ukukhipha isidoda emasendeni (testicular sperm extraction) kuwuhlinzo lokukhipha isidoda emasendeni. Kuwusizo emadodeni angakwazi ukuchama isidoda ngenxa yezizathu ezahlukene.

Amadoda anokuvinjelwa noma ukungabi bikho kwe-vas deferens avame ukudinga i-TESE. I-vas deferens iyithumbu elithwala isidoda lisuka emasende. Isebenza kahle futhi emadodeni anenani eliphansi kakhulu lezidoda.

Uchwepheshe wenza i-TESE ngaphansi kwe-anesthesia ejwayelekile noma yendawo. Ukukhetha kuncike endleleni ethile esetshenzisiwe kanye nezingxenyekazi zokunethezeka zesiguli.

Izindlela Ezihlukene ze-TESE

Kukhona izindlela eziningana zokuthola isidoda noma ukukhipha isidoda. Iyiphi indlela ezokusebenzela kangcono incike esimweni sakho nokuqeqeshwa kodokotela.

Izindlela ezintathu eziyinhloko ze-TESE yilezi:

1. I-TESE Evamile
2. I-Microdissection TESE (Micro-TESE)
3. Ukudonsa Isidoda Esivela Ku-Epididymis Ngokubhoboza (PESA)

Ake sixoxe ngazo zonke izici zobuchwepheshe be-TESE ngokuningiliziwe:

1. I-TESE Evamile

I-TESE evamile iyona ndlela esetshenziswa kakhulu [3]. Ku-TESE evamile, udokotela wenza ukusikwa okuncane emasende bese ekhipha ucezu oluncane lwendwangu.

Le ndwangu/izicubu bese kuhlolwa ngaphansi kwemayikhrosikhophi ukuze kubhekwe ukutholakala kwesidoda esiphilayo. Uma sezitholakele izidoda eziphilayo, zingasetshenziswa ku-In Vitro Fertilization.

Nakuba i-TESE evamile ilula ukuyenza, kunzima ukuthola inani elikhulu lezidoda usebenzisa le ndlela.

2. I-Microdissection TESE (Micro-TESE)

I-Micro-TESE iyindlela ethuthukile kakhulu lapho kusetshenziswa imayikhrosikhophi enamandla amakhulu ukuze kufinyelelwe endaweni emasende lapho kungaba khona isidoda [4]. Ngemva kokuthola izicubu eziqukethe isidoda, ikakhulukazi ama-seminiferous tubules, lezi zicubu zikhishwa ngezimbobo ezincane ezenziwe ngohlinzo.

Inqubo ye-Micro TESE ingena kancane emzimbeni futhi ingakhipha amaseli esidoda amaningi kunendlela evamile ye-TESE. Ucwaningo lomagazini i-Andrology lubonisa ukuthi i-microdissection TESE ikhipha cishe u-20% wesidoda esiningi uma kuqhathaniswa ne-TESE evamile [5].

Ukudonsa Isidoda Esivela Ku-Epididymis Ngokubhoboza (PESA)

I-Percutaneous Epididymal Sperm Aspiration, noma i-PESA, ingeyokuhlinzwa okuncane kakhulu kuno-micro-TESE [6]. I-PESA ihilela ukufakwa komjovo (inaliti) ku-epididymis ukuze kukhishwe isidoda emabeleni (testicular sperm aspiration). I-epididymis iwushubhu osemlenze ongemuva wamabele othola isidoda esivela emabeleni.

Inqubo ye-PESA ilula ezigulini kodwa ingase ingafaneli wonke umuntu. Le ndlela ivamise ukusebenza kahle uma ukukhiqizwa kwesidoda kujwayelekile emabeleni, kodwa kukhona ukuvinjelwa ku-vas deferens, okuvimba isidoda ekuphumeneni ngesikhathi sokushaya (ejaculation).

3. IVF Isebenza Kanjani Kumuntu Wesilisa?

Ku-IVF, kudingeka isidoda esisaphila ukuze sichanyusele iqanda elabhorethri. Nokho, amadoda anesimo se-azoospermia angase angabi nasidoda ekushayweni (ejaculate). Lapha yilapho ukukhipha isidoda nge-TESE kudlala khona indima ebalulekile ku-IVF. Le ndlela isiza ukukhipha isidoda esisaphila ngaphakathi emabeleni ukuze sisetshenziswe ku-IVF.

Kulabo abahamba ngenqubo yokwelashwa kokungabi nenzalo, ukuqonda inqubo ye-sperm collection for IVF kubalulekile, ngoba kudlala indima ebalulekile ekuqinisekiseni ukuthi kukhona isidoda esisebenzayo esitholakalayo sokuchanyushelwa. Isidoda esikhiphwe nge-TESE bese sihlanganywa namaqanda omlingani noma omnikezeli elabhorethri. Isidoda sichanyusela iqanda kwakheke umbungu (embryo), bese lowo mbungu ufakelwa esibelethweni sowesifazane.

Ngale ndlela, i-TESE isiza amadoda anezinkinga ezithile zokuzala ukuba abe nezingane ezizalwa ngabo mathupha.

Kubantu besilisa abafuna ukuthuthukisa impilo yesidoda, Conceive Plus Motility Support inikeza amanyuvesi abalulekile afana ne L-Carnitine ne-Coenzyme Q10 ukuze kuthuthukiswe ukunyakaza kwesidoda (sperm motility), okuwumgogodla ekufezeni ukuchanyushelwa okuyimpumelelo.

Ukulungiselela i-TESE

Ngaphambi kwe-TESE noma inqubo yokuhlinza yokukhipha isidoda, udokotela uzohlola ngokuningiliziwe isimo sakho sokuzala kanye nempilo yakho yonke yokuzalana. Lokhu kuhlanganisa nokuhlolwa kwegazi ukuze kubhekwe amazinga amahomoni kanye nezithombe zokuhlola imbele (testes).

Ngosuku lwenqubo, udokotela angakweluleka ukuthi udle noma ugweme uhlobo oluthile lokudla. Ungase futhi udinge ukuyeka ukuthatha eminye imithi ngaphambi kwenqubo, ngoba eminye imithi ingase ixhumane kahle noma kabi ne-anesthesia [7].

Ingabe Ukukhipha Isidoda Emabeleni Kuyingozi?

Njenganoma iyiphi enye inqubo yokuhlinza, ukukhipha isidoda esivela emabeleni (testicular sperm extraction) kunezingozi ezithile, njengekubhema igazi nokutheleleka. Kwezinye izimo, kungabangela ukulimala okukhulu ezicubini zamaphaphu esidoda (testicular tissues).

Nokho, imiphumela emibi incane futhi ingagwenywa ngokulandela imihlahlandlela yokuphepha. Amadoda amaningi ayelulama emasontweni ambalwa ngemva kwenqubo ye-TESE [8].

Imibuzo Evame Ukubuzwa

1. Indlela yokukhipha isidoda emzimbeni wakho wesilisa?

Kukhona izindlela ezahlukene zokukhipha isidoda emzimbeni wendoda. Nokho, ukukhipha isidoda emabeleni (Testicular sperm extraction) yindlela evame kakhulu enemiphumela ephumelelayo.

2. Ingabe kukhona inzuzo yokukhipha isidoda emabeleni mayelana nokuzala?

Ukukhipha isidoda emabeleni kunikeza isidoda esisaphila esingasetshenziswa ku-IVF. Ku-IVF, isidoda esikhiwe sivundisa iqanda sakhe umbungu.

3. Ingabe i-TESE inqubo ebuhlungu?

I-TESE ngokuvamile yenziwa ngaphansi kwe-anesthesia yendawo noma ejwayelekile, ukuze ungazizwa ubuhlungu ngesikhathi senqubo. Ukungakhululeki okuthile noma ukuvuvukala kungavela ngemuva kwenqubo kodwa ngokuvamile kuyancipha ezinsukwini ezimbalwa.

Okubalulekile Ekugcineni

Ukukhipha isidoda emabeleni (testicular extraction of sperm) kuyinqubo eyinkimbinkimbi yokwelapha ukungabi nenzalo emadodeni kodwa inezinga eliphezulu lokuphumelela. Le nqubo yokuvuna isidoda noma ukukhipha isidoda ihilela ukukhipha amaseli esidoda emabeleni ngokusika noma i-micro-dissection.

Amaseli esidoda asebenzisa khona-ke ukwenziwa kokufakelwa imbewu ngaphandle komzimba (In Vitro Fertilization, IVF). I-TESE ehlanganiswe ne-IVF ingasiza indoda engazalayo ukuba ibe nguyise wengane yakhe yakuzalwa.

Izinsiza Esetshenzisiwe

1. MedlinePlus. In Vitro Fertilization. U.S. National Library of Medicine. Kuthathwe ku- https://medlineplus.gov/ency/article/007279.htm
2. Sharma, M., & Leslie, S. W. (2023, Novemba 18). I-Azoospermia. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK578191/ 
3. Saccà, A., Pastore, A. L., Roscigno, M., Naspro, R., Pellucchi, F., Fuschi, A., Maruccia, S., Territo, A., Pisano, F., Zanga, L., Capitanio, E., Carbone, A., Fusi, F., Chinaglia, D., & Da Pozzo, L. F. (2016). I-testicular sperm extraction (TESE) ejwayelekile kanye ne-non-obstructive azoospermia: Ingabe kusekukhona ithuba esikhathini se-microdissection TESE? Imiphumela esuka esibhedlela esisodwa somphakathi esingezona ezemfundo. I-Andrology, 4(3), 425-429. https://doi.org/10.1111/andr.12159
4. Achermann, A. P. P., Pereira, T. A., & Esteves, S. C. (2021). I-microdissection testicular sperm extraction (micro-TESE) emadodeni anenkinga yokungazali ngenxa ye-nonobstructive azoospermia: isifinyezo sezincwadi zamanje. International urology and nephrology, 53(11), 2193–2210. https://doi.org/10.1007/s11255-021-02979-4
5. Deruyver, Y., & Vanderschueren, D. (2013). Umphumela we-microdissection TESE uma kuqhathaniswa ne-TESE ejwayelekile ku-non-obstructive azoospermia: Uhlaziyo olunhlelekile. I-Andrology, 2(1), 20-24. https://doi.org/10.1111/j.2047-2927.2013.00148.x
6. Esteves, S. C. (2015). I-percutaneous epididymal sperm aspiration njengendlela yokuthola isidoda emadodeni anokungavinjwa kwesidoda (obstructive azoospermia) abafuna ukuzala: Izingxenye zokuhlinza nezaselabhorethri. International Brazilian Journal of Urology : Official Journal of the Brazilian Society of Urology, 41(4), 817-818. https://doi.org/10.1590/S1677-5538.IBJU.2015.0064
7. Egan, T. D., & Minto, C. F. (2013). Ukusebenzisana kwemithi kwe-pharmacodynamic ekunakekelweni kobuhlungu (anesthesia). Ku-Cambridge University Press eBooks (amakhasi 147–165). https://doi.org/10.1017/cbo9780511781933.012
8. Professional, C. C. M. (2024, Meyi 1). Microsurgical Testicular Sperm Extraction (microTESE). Cleveland Clinic. https://my.clevelandclinic.org/health/procedures/microtese 

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