(142) Proposed Algorithm for Decision Making During Microdissection Testicular Sperm Extraction (m-TESE) in Men with Non-Obstructive Azoospermia (NOA)

Abstract

Abstract Introduction Microdissection testicular sperm extraction (m-TESE) is currently proven to yield the highest sperm retrieval rates in men with non-obstructive azoospermia (NOA). Although considered a low-risk procedure in experienced hands, performance of bilateral m-TESE may result in increased complication rate. Several studies examine preoperative factors as candidates for surgical counseling and prediction of m-TESE success, with most suggesting their combination. Objective We propose an intra-operative algorithm which may aid with patient counseling and ultimately prediction of success, while minimizing the surgical risks. Methods Consecutive records of patients with NOA who underwent m-TESE at our institution between August 2019 and June 2022 were queried retrospectively. Patient demographics, pre-operative workup, intra-operative maneuvers and post-operative follow-up data were analyzed with use of standard statistics. Results Records of seventeen men were identified. Average patient age was 38 years (range: 29-46yo). Eight men had prior testis biopsy results available and two others had prior m-TESE performed. Seven men underwent a bilateral m-TESE. Sperm was successfully identified in ten men (58.8%). Eight of these men (80%) underwent a unilateral m-TESE. Men with the successful m-TESE had an average pre-operative FSH level of 10.1 IU/ml (5.4-21.6 IU/ml) and Inhibin B (INHB) level of 90.2 pg/ml (23.3-186.5 pg/ml). The remaining seven men had no sperm identified (41.2%). Two of these men had prior testicular interventions (testis biopsy with SCO, prior unsuccessful m-TESE) and thus underwent a unilateral (28. 6%), while the remaining five underwent a bilateral m-TESE (71.4%). Their FSH and INHB were 16.9 IU/ml (3.6-26.6 IU/ml) and 56.5 pg/ml (6.9-209.5 pg/ml), respectively. A cut-off value of 30pg/ml of INHB and presence of SCO on prior testis biopsy results were used to develop an intra-operative algorithm (Figure 1). Conclusions This study proposes a straightforward decision-making process for men with NOA undergoing m-TESE. Systematic use of few predictive factors may improve patient preoperative counseling, decrease surgical times and complication risk. Additional work is necessary to fully examine the validity and applicability of the proposed algorithm. Disclosure No