MP21-02 TESTICULAR CORE BIOPSY: A NEW PARADIGM FOR THE DIFFERENTIAL DIAGNOSIS OF AZOOSPERMIA

Abstract

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation I (MP21)1 Sep 2021MP21-02 TESTICULAR CORE BIOPSY: A NEW PARADIGM FOR THE DIFFERENTIAL DIAGNOSIS OF AZOOSPERMIA Kevin Campbell, John Sullivan, Oscar Velazquez, and Larry Lipshultz Kevin CampbellKevin Campbell More articles by this author , John SullivanJohn Sullivan More articles by this author , Oscar VelazquezOscar Velazquez More articles by this author , and Larry LipshultzLarry Lipshultz More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002006.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Men presenting to infertility clinics with idiopathic azoospermia must often undergo surgical sperm extraction to proceed with assisted reproductive therapy. These men are counseled towards an in-office testicular sperm extraction (TESE) or an operating room microsurgical testicular sperm extraction (mTESE). Previous studies have reported testicular fine needle aspiration using a 23-gauge needle as a diagnostic tool for obtaining material for only limited cytological evaluation of spermatogenesis and interstitial cells.Herein we report our experience with an in-office testicular core biopsy (TCB) similar to the technique popularized by the Mayo Clinic for breast lesion diagnosis. TCB of seminiferous tubules using a large bore needle (18-gauge) establish a new non-invasive paradigm for the differential diagnosis of azoospermia. METHODS: Men with azoospermia presenting to a single site men’s health clinic from 2018-2020 were offered diagnostic TCB prior to a sperm extraction procedures. Patients with sperm found on office TCB were offered office TESE while those without sperm on the TCB were recommended for microscopic sperm retrieval under general anesthesia in the operating room. RESULTS: A total of 40 men with idiopathic azoospermia presented to our clinic and underwent diagnostic testicular TCB. 28 (70%) of these patients had sperm observed in the tissue core. These patients were recommended for sperm extraction with in-office TESE. Follow-up demonstrated a positive predictive value of 100% (14/14) for the presence of sperm at the time of in-office TESE following a positive TCB. These 14 men avoided mTESE with a cost savings of $8,145 per patient. 12 patients with a positive TCB had yet to undergo sperm extraction at the time of data review.Of the patients with no sperm seen on TCB, 4 underwent mTESE. Only 1 patient with a negative TCB was found to have sperm at an initial OR biopsy prior to mTESE, giving a TCB false negative rate of 25% (1/4). 75% of patients with a negative LNA avoided an unnecessary in-offce TESE with a cost savings of $1600 per person. No adverse outcomes were reported as a result of TCB. Additionally, patients with a history of vasectomy who underwent TCB prior to TESE or reversal demonstrated a positive predictive value of 100% (5/5) for the presence of sperm in the TESE sample (3/3) or in the vasal fluid (2/2). CONCLUSIONS: TCB is a safe and cost-effective diagnostic procedure to aid in sperm extraction for the differential diagnosis of azoospermia. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e346-e346 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Campbell More articles by this author John Sullivan More articles by this author Oscar Velazquez More articles by this author Larry Lipshultz More articles by this author Expand All Advertisement Loading ...