(267) SPERM EXTRACTION IN MEN INTERESTED IN FERTILITY AFTER RADICAL PROSTATECTOMY

Abstract Introduction Radical prostatectomy (RP) is associated with permanent failure to ejaculate. It is estimated that up to 40% of men after RP do not remember being told they will never ejaculate postoperatively and very few have heard of sperm banking prior to RP. Clinical experience has demonstrated that some men regret not banking sperm pre-RP and present for a discussion regarding sperm extraction. Objective To review our experience with sperm extraction in men post-RP. Methods We review our experience at a specialist andrology practice regarding post-RP sperm extraction over the past two decades. The study population included men who (i) were post-RP (ii) requested future fertility (iii) with available pre-sperm extraction FSH levels (iv) and partners with documented fertility potential (normal FSH/AMH levels). All patients underwent attempted vasal sperm aspiration (VA). If this was of poor quality - azoospermia, low motility (<5%) - microsurgical epididymal sperm aspiration (MESA) was attempted and when no sperm/poor motility was found, testis tissue extraction (TESE) was performed. Results A total of 16 sperm extractions have been performed over this time period. Median patient age 48 (44, 62) years, partner age 36 (32, 41) years. Baseline median testicular volume on clinical examination 16 (14, 18) mls; total early morning testosterone level 480 (340, 690) ng/dl, FSH 4.5 (2, 8) mU/ml. All patients had successful vasal fluid retrieval, 12/16 (75%) had good quality specimens on microscopy, median sperm concentration of 32 M/ml, forward motility rate of 20%. Three had very low concentration (<5/HPF on intraoperative microscopy) or motility (<5%). All of these men underwent attempted MESA, with again low motility rates. These three and the single patient with azoospermia on VA underwent TESE and all had sperm found. The median number of vials across all patients/forms of sperm extraction was 8 (4, 16). Conclusions Sperm extraction is a viable option for men requesting reproductive assistance after RP, with vasal aspiration being successful in the vast majority of these patients, especially in men with normal baseline FSH levels. Counseling patients about failure to ejaculate and the option of sperm banking should be considered prior to RP. Disclosure No.