FNA mapping before micro-TESE

Widi Atmoko, Marah Hehemann, Juan Andino

The VJSM presents an episode of the Debate Series with moderator Dr. Widi Atmoko and guests Dr. Marah Hehemann and Dr. Juan Andino. This debate focuses on the role of fine-needle aspiration (FNA) mapping before micro-TESE in men with non-obstructive azoospermia, specifically whether FNA mapping should be incorporated into routine clinical practice prior to surgical sperm retrieval.

Dr. Hehemann presents a compelling argument in favor of FNA mapping, highlighting its potential to improve patient counseling, guide treatment decisions, reduce procedural morbidity, and enhance cost-effectiveness while maintaining comparable pregnancy and live birth outcomes. In contrast, Dr. Andino presents a thoughtful defense of upfront micro-TESE as the current gold standard, emphasizing guideline recommendations, established sperm retrieval success rates, and the importance of individualized patient care and shared decision-making.

This debate provides valuable insights into a rapidly evolving area of male infertility care. The discussion explores clinical outcomes, patient-centered decision-making, cost considerations, emerging technologies, and future directions in sperm retrieval strategies. Urologists, andrologists, reproductive specialists, and other clinicians involved in the management of non-obstructive azoospermia will find this debate both informative and thought-provoking.