MP31-03 MICRODISSECTION TESTICULAR SPERM EXTRACTION VS MULTIPLE NEEDLE-PASS PERCUTANEOUS TESTICULAR SPERM ASPIRATION IN MEN WITH NON-OBSTRUCTIVE AZOOSPERMIA: A RANDOMIZED CLINICAL TRIAL

Abstract

You have accessJournal of UrologyInfertility: Therapy (MP31)1 Sep 2021MP31-03 MICRODISSECTION TESTICULAR SPERM EXTRACTION VS MULTIPLE NEEDLE-PASS PERCUTANEOUS TESTICULAR SPERM ASPIRATION IN MEN WITH NON-OBSTRUCTIVE AZOOSPERMIA: A RANDOMIZED CLINICAL TRIAL Christian Fuglesang S. Jensen, Dana A. Ohl, Mikkel Fode, Niels Jørgensen, Aleksander Giwercman, Angel Elenkov, Anna Klajnbard, Claus Y. Andersen, Lise Aksglaede, Marie Louise Grøndahl, Mette C. Bekker, and Jens Sønksen Christian Fuglesang S. JensenChristian Fuglesang S. Jensen More articles by this author , Dana A. OhlDana A. Ohl More articles by this author , Mikkel FodeMikkel Fode More articles by this author , Niels JørgensenNiels Jørgensen More articles by this author , Aleksander GiwercmanAleksander Giwercman More articles by this author , Angel ElenkovAngel Elenkov More articles by this author , Anna KlajnbardAnna Klajnbard More articles by this author , Claus Y. AndersenClaus Y. Andersen More articles by this author , Lise AksglaedeLise Aksglaede More articles by this author , Marie Louise GrøndahlMarie Louise Grøndahl More articles by this author , Mette C. BekkerMette C. Bekker More articles by this author , and Jens SønksenJens Sønksen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002035.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Non-obstructive azoospermia (NOA) is a severe infertility diagnosis. No level-1 evidence supports a specific surgical sperm retrieval procedure. Microdissection testicular sperm extraction (mTESE) has gained popularity due to reports on relatively high sperm retrieval rates (SRR) ranging 30–70%. However, mTESE is an invasive, demanding and costly procedure. We previously reported SRR for a modified needle aspiration (TESA) applied in NOA men (Jensen et al. 2016). Modified TESA is done with an 18-gauge needle performing multiple passes (50-100) while applying a vacuum. The SRR from this procedure was 30%. When performing salvage mTESE after an unsuccessful modified TESA, the SRR was only 11%. Therefore, we hypothesized that modified TESA is an effective alternative to mTESE. Accordingly, we conducted the first randomized clinical trial on surgical sperm retrieval in NOA men comparing modified TESA with mTESE. METHODS: Ethical approval was obtained, and a prospective randomized clinical trial was conducted between 04/2017–10/2020. Inclusion criteria were azoospermia according to WHO, testis volume ≤15ml and no indication of obstructive causes of azoospermia. Exclusion criteria were previous surgical sperm retrieval or testicular biopsy, anejaculation, retrograde ejaculation, Klinefelter’s Syndrome, XX male, AZFa/b microdeletion and CFTR mutation. The calculated population size was 100 (using 25% SRR for TESA and 52% for mTESE, power 80% and alpha 0.05) and with an expected drop-out rate of 10%, 110 men with NOA needed to be included. Men were randomized to mTESE or modified TESA. Patients with a failed TESA proceeded directly to mTESE while in the operating room. The primary outcome was successful sperm retrieval. SRRs were compared using Chi-square test. Statistical significance was set at p<0.05. RESULTS: 110 men were included, 10 withdrew before randomization and 100 underwent surgery. Median age was 33 years (range 22–54). Spermatozoa were retrieved in 11/51 (22%) men randomized for TESA and 21/49 (43%) men undergoing mTESE (p=0.02). SSR from salvage mTESE was 4/38 (11%). Thus, the combined SRR for men randomized to TESA was 15/51 (29%) which did not reach statistical significance compared to mTESE (p=0.16). CONCLUSIONS: In direct comparison SRR was higher in mTESE compared to modified TESA. Although not powered for such comparison, the study may indicate that combining salvage mTESE with the modified TESA is a viable alternative reducing invasiveness and cost for a proportion of patients. Source of Funding: European Reasearch Council, ReproUnion © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e555-e556 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christian Fuglesang S. Jensen More articles by this author Dana A. Ohl More articles by this author Mikkel Fode More articles by this author Niels Jørgensen More articles by this author Aleksander Giwercman More articles by this author Angel Elenkov More articles by this author Anna Klajnbard More articles by this author Claus Y. Andersen More articles by this author Lise Aksglaede More articles by this author Marie Louise Grøndahl More articles by this author Mette C. Bekker More articles by this author Jens Sønksen More articles by this author Expand All Advertisement Loading ...