Development of a Predictive Nomogram for Testicular Sperm Extraction Outcomes in Non-Obstructive Azoospermia Patients Using Testicular Volume, Follicle-Stimulating Hormone, and Testosterone Levels as Key Parameters

Objective: To investigate the establishment of a predictive model for the outcomes of testicular sperm extraction (TESE) surgery in patients with non-obstructive azoospermia (NOA). Methods: We conducted a retrospective analysis of patients who visited the andrology outpatient clinic at the First Affiliated Hospital of Soochow University from January 2010 to January 2024. A total of 425 patients’ clinical data were included in the study. All patients underwent TESE surgery, with 216 cases in the sperm-positive group and 209 cases in the sperm-negative group. Differences in testicular volume, reproductive hormone levels, and clinically relevant parameters between the two groups were compared. Multivariate logistic regression analyze was performed to identify independent risk factors, which were then used to establish a predictive nomogram model. The model’s goodness-of-fit was evaluated using a calibration curve. The diagnostic effectiveness of the model was assessed through the receiver operating characteristic (ROC) curve, while the net benefit was evaluated using a decision curve analysis (DCA) plot. Results: Univariate analysis revealed that serum follicle-stimulating hormone (FSH), body mass index (BMI), seminal plasma fructose, elastase levels, and testicular microlithiasis differed significantly between the two groups (p

研究目的：探讨非梗阻性无精子症（non-obstructive azoospermia, NOA）患者睾丸精子提取术（testicular sperm extraction, TESE）手术结局的预测模型构建。方法：回顾性分析2010年1月至2024年1月于苏州大学附属第一医院男科门诊就诊的患者，共纳入425例患者的临床资料。所有患者均接受TESE手术，其中精子阳性组216例，精子阴性组209例。比较两组患者的睾丸体积、生殖激素水平及临床相关参数的差异。采用多因素logistic回归分析筛选独立危险因素，并以此构建预测列线图模型。通过校准曲线评估模型的拟合优度，通过受试者工作特征（receiver operating characteristic, ROC）曲线评估模型的诊断效能，通过决策曲线分析（decision curve analysis, DCA）图评估净获益。结果：单因素分析结果显示，两组患者的血清卵泡刺激素（follicle-stimulating hormone, FSH）、体质量指数（body mass index, BMI）、精浆果糖、弹性蛋白酶水平及睾丸微石症差异均具有统计学意义（p