MP30-05 CONCORDANCE OF TESTIS HISTOLOGY AMONG MEN UNDERGOING BILATERAL TESTICULAR SPERM EXTRACTION PROCEDURES

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP30-05 CONCORDANCE OF TESTIS HISTOLOGY AMONG MEN UNDERGOING BILATERAL TESTICULAR SPERM EXTRACTION PROCEDURES Jessica Marinaro, Jonathan Gal, and James Kashanian Jessica MarinaroJessica Marinaro More articles by this author , Jonathan GalJonathan Gal More articles by this author , and James KashanianJames Kashanian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003258.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: For men undergoing a microdissection testicular sperm extraction (mTESE) procedure, if sperm are not found in one testis, a bilateral procedure is typically performed; however, this invasive dissection may have adverse effects. While testicular histology may predict sperm retrieval rates (SRRs), little is known about the concordance of histology between testes. Since this may inform the utility of performing a bilateral versus unilateral dissection, our objective was to assess the rate of histological concordance between left and right testis biopsies and as well as the overall sperm retrieval rate (SRR) for these patients. METHODS: We retrospectively reviewed electronic medical records using CPT codes 55899 and 54505 for 1 surgeon from 6/2016 to 8/2022. Men were included if they underwent a testicular sperm extraction (TESE) or mTESE procedure. Biopsies were evaluated by 4 pathologists at our institution. Histology was classified as Sertoli-cell only (SCO), maturation arrest (MA; early or late), active spermatogenesis (AS), or tubular atrophy (TA). Each pattern was reported as a percentage contributing to a total of 100%. A successful sperm retrieval was defined as the presence of sperm after processing by an andrology lab. RESULTS: Of 128 men who underwent a TESE or mTESE, 38 (29.7%) had a bilateral procedure. Mean demographics for these 38 men included an age at surgery of 39.4 ± 7.0 years, baseline testosterone 400.1 ± 198.0 ng/dL, baseline FSH 18.7 ± 14.9 mIU/mL, right testis volume 10.1 ± 6.4 mL, and left testis volume 10.2 ± 6.4 mL. Thirty-one men (31/38, 81.6%) had biopsies sent for histology from both testes. Of these, 9 (29.0%) had the same histology in the same proportions bilaterally, 14 (45.2%) had the same predominant histology but in variable proportions, and 8 (25.8%) had discordant predominant histology. Ten of 31 men (32.3%) had sperm retrieved; of these, 6 (60%) had no evidence of spermatogenesis on either histology specimen. CONCLUSIONS: While it is known that there is often heterogeneity within the testis, this study confirms that there is also significant heterogeneity between each testis for >25% of men. Though histology may help to predict SRRs, this study emphasizes that histology alone is not reliable in determining which men will have sperm present after processing by an andrology lab. Ultimately, while histology may provide patients and providers with useful information on testicular architecture, it should not be the only factor in clinical decision making, such as who should undergo a bilateral procedure or repeat procedure. Source of Funding: Authors JM and JG are supported in part by the Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e392 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jessica Marinaro More articles by this author Jonathan Gal More articles by this author James Kashanian More articles by this author Expand All Advertisement PDF downloadLoading ...