Role of testicular fine‐needle aspiration in the modern male reproductive urologist′s practice

Abstract Background Azoospermia affects 10%–15% of infertile men, with non‐obstructive azoospermia (NOA) most often managed by microdissection testicular sperm extraction (mTESE). Despite AUA/ASRM guidelines recommending mTESE, some urologists employ testicular fine‐needle aspiration (TFNA) mapping as a diagnostic adjunct. This study assessed current attitudes and utilization of TFNA mapping among fellowship‐trained male reproductive urologists. Methods An eight‐item anonymous Qualtrics survey was distributed to 96 fellowship‐trained male reproductive urologists identified through the Society for the Study of Male Reproduction. Questions addressed experience with TFNA mapping, reasons for use or discontinuation, and perceived clinical value. Results Thirty‐two surveys were completed (33% response rate). Ten respondents (31%) reported experience with TFNA mapping; six currently use it and four had discontinued use. Reported reasons for discontinuation included poor results (50%), lack of laboratory access (25%), and other factors (25%). Urologists who never used mapping primarily proceeded directly to mTESE. Among current users, management decisions following mapping varied: if no sperm were found, 50% referred to donor sperm and 50% proceeded with mTESE; if rare sperm were identified, 75% performed targeted testicular sperm extraction (TESE) and 25% mTESE; if abundant sperm were observed, 75% proceeded with testicular sperm aspiration (TESA). All current users (100%) agreed TFNA mapping provided valuable prognostic information for counseling NOA patients. Conclusion Although underutilized, TFNA mapping is regarded as a useful diagnostic and prognostic tool by current users. Broader adoption may be facilitated through improved laboratory access, training, and cost‐effectiveness analyses.