(263) IS THERE STILL A ROLE FOR TESTICULAR FINE NEEDLE ASPIRATION MAPPING IN THE TESTICULAR MICRODISSECTION ERA?

Abstract Introduction Finding sperm in men with non-obstructive azoospermia (NOA) can be challenging. Over the years, reproductive urologists have used a number of different strategies to maximize sperm retrieval rates and the testicular microdissection (mTESE) has been crowned the winner. Objective Some urologists perform testicular fine needle aspiration mapping (TFNA mapping) despite the fact that mTESE is the sperm retrieval surgery of choice. Why is this? The present investigation investigated the role of TFNA mapping in the present era. Methods We obtained from the “Find an SSMR Doctor” section of the Society for The Study of Male Reproduction (SSMR) email addresses of fellowship-trained male reproductive urologists and sent to them an 8-question survey. We queried the clinician’s attitudes toward TFNA mapping and how, if at all, this procedure fits into their own practices. Results Out of 96 surveys sent, we received a total of 32 responses (33% response rate). Of the 32, only 10 had any experience whatsoever with TFNA mappings. 6/10 reported that they currently used TFNA mapping with 4/10 respondents reporting that they used to use it but no longer do. Reasons cited for abandoning mapping included poor results (50%), limited or no access to a laboratory for interpretation (25%), and other (25%). The 6 clinicians that currently used TFNA mapping answered subsequent follow-up questions regarding their usage. If mapping failed to find any sperm at all, then urologists were split 50/50 on either referring for donor sperm or proceeding to mTESE. If mapping found rare sperm only then the majority of respondents proceeded to targeted TESE (75%) as opposed to mTESE (25%). In the event that a mapping resulted in copious amounts of sperm, 75% of clinicians indicated that they would proceed to testicular sperm aspiration as opposed to standard TESE (75% vs 25%). 100% current users of TFNA mapping found that the information gained from the procedure was valuable when counseling patients with non-obstructive azoospermia. Conclusions The mTESE is a difficult operation that requires a high level of andrology and embryology support that is simply outside the reach of many urologists that practice male reproductive urology. In contrast, the TFNA mapping is quick and easy to perform. The present study, with all its obvious limitations, demonstrates that some fellowship trained male reproductive urologists utilize TFNA mapping and find it helpful. Urologists that use mapping can avoid mTESE for their patients in certain situations and use the information gained from mapping to guide further management. The survey also indicates that inadequate access to quality laboratories for interpretation is an impediment to TFNA mapping usage. Disclosure No.