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Ebook Atlas of office based andrology procedures: Part 2

(BQ) Part 2 book “Atlas of office based andrology procedures” has contents: Nonsurgical sperm retrieval, subcutaneous testosterone pellet insertion, intralesional collagenase injection, intralesional verapamil, penile traction device training, intracavernosal injection training, and other contents. | Chapter 9 Nonsurgical Sperm Retrieval John P. Mulhall and Lawrence C. Jenkins Introduction Nonsurgical sperm retrieval is a less-invasive process compared to surgical sperm retrieval. Nonsurgical procedures include percutaneous testicular sperm aspiration or biopsy and percutaneous epididymal sperm aspiration. These techniques are a less-invasive and usually less-expensive alternative to the open surgical techniques. However, it is important that the right patient is chosen, ideally a male with normal spermatogenesis (obstructive azoospermia). In addition, there is usually significantly lower numbers of sperm recovered using percutaneous methods compared to open. Indications These procedures can be used when there is a reasonable spermatogenesis, normal lab values suggesting azoospermia resulting from vasectomy, bilateral vassal obstruction (inguinal hernia surgery associated injury), or congenital absence of bilateral vas deferens. J.P. Mulhall, MD, MSc, FECSM, FACS (*) • L.C. Jenkins, MD, MBA Department of Surgery, Section of Urology, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, Suite 402, New York, NY 10022, USA e-mail: Mulhalj1@mskcc.org; JenkinL1@mskcc.org © Springer International Publishing Switzerland 2017 J.P. Mulhall, L.C. Jenkins (eds.), Atlas of Office Based Andrology Procedures, DOI 10.1007/978-3-319-42178-0_9 63 64 J.P. Mulhall and L.C. Jenkins Pre-procedural Considerations Serum FSH level should be obtained to assess testicular function prior to deciding between percutaneous and open approaches. The lab values can be used in conjunction with testicular volume as a predictor of spermatogenesis (obstructive azoospermia likely when FSH less than 7.6 mIU/mL or testicular long axis greater than 4.6 cm). Having an embryologist available for real-time analysis of testicular tissue specimen is considered ideal bit often not possible. Procedure In the office setting, a medication like diazepam may be helpful to lower the .