MP43-01 DOES INTRA-OPERATIVE MICROSCOPIC SPERM EVALUATION IMPACT MTESE SPERM RETRIEVAL RATES FOR MEN WITH NOA?: A PROPORTIONAL META-ANALYSIS

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP43-01 DOES INTRA-OPERATIVE MICROSCOPIC SPERM EVALUATION IMPACT MTESE SPERM RETRIEVAL RATES FOR MEN WITH NOA?: A PROPORTIONAL META-ANALYSIS Brittany Berk, John Ernandez, Catherine Gu, Alexandra Berger, and Martin Kathrins Brittany BerkBrittany Berk More articles by this author , John ErnandezJohn Ernandez More articles by this author , Catherine GuCatherine Gu More articles by this author , Alexandra BergerAlexandra Berger More articles by this author , and Martin KathrinsMartin Kathrins More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003289.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Microsurgical testicular sperm extraction (mTESE) is the gold standard for surgical sperm retrieval in men with nonobstructive azoospermia (NOA). Intraoperative table-top microscopic specimen analysis can be utilized to identify viable sperm for in-vitro fertilization, and also provides information regarding the necessity of bilateral testicular exploration and helps determine the end of the surgery. In this study, we investigated the impact of intraoperative microscopic analysis on mTESE sperm retrieval rates (SRR). METHODS: A PubMed search was performed for studies on men with NOA undergoing mTESE with a primary outcome of SRR. Studies on obstructive azoospermia, Klinefelter’s syndrome cohorts, and review articles were excluded. Only the most recent publication from a given academic institution’s cohort was considered (Figure 1). Each study was categorized based on whether the manuscript described utilization of intraoperative microscopy to identify viable sperm. The number of patients who underwent mTESE, and the number of patients who had successful sperm retrieval, were recorded for each study and combined within groups. Differences in SRR between the groups was determined using Chi-square testing. RESULTS: 182 articles were identified in our initial search, of which 36 were included in the final analysis. 20 studies were categorized as “(+) Intraoperative Microscopic Guidance”, and 7 studies were “(-) Intraoperative Microscopic Guidance”. In the (+) group, a total of 3923 cases were included with a cumulative SRR of 51.0% (95% CI 49.4–52.5, and in the (-) group, a total of 877 cases were included with a cumulative SRR of 46.0% (95% CI 42.7–49.4). The estimated difference in SRR between the two groups was 4.94% [95% CI 1.28%-8.57%]. On chi-squared analysis, there was a statistically significant difference in SRR [X2=7.007; p = 0.0081]. CONCLUSIONS: In this proportional meta-analysis, we found a significantly higher SRR for men with NOA undergoing mTESE with intraoperative microscopic analysis. These findings support increased utilization of real time microscopic assessment of specimens to guide intraoperative decision-making and optimize outcomes while also possibly preventing unnecessary extensive exploration. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e601 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brittany Berk More articles by this author John Ernandez More articles by this author Catherine Gu More articles by this author Alexandra Berger More articles by this author Martin Kathrins More articles by this author Expand All Advertisement PDF downloadLoading ...