FNA Mappingにつきより深くご理解いただくために、わかりやすい図を追加して説明文をアップしました。東京都五反田のメンズファーティリティクリニック東京では受診された際に約30分の説明ビデオをご覧いただくことができます。2022年４月からmicro TESEが保険適応となり、必ずしも品質が高くない手術が増えてきています。こうした状況に対して元米国アンドロロジー学会会長でUCSF主任教授だったDr. Turekから、日本において温度差が著しいmicro TESEを標準手術とすることに対して以下の警鐘とするコメントがかなり控えめな表現ながら寄せられています。 Upon observing Japanese Male Fertility treatments, I was taken back by the statement that there is evidence for using micro TESE for patients with non-obstructive azoospermia. High level evidence requires randomized, controlled trials to achieve and there are no such trials to support the use of micro TESE over any other sperm retrieval technique. I agree that it is becoming popular among Japanese urologists, but this alone does not make it the best approach. Here are some other reasons to avoid labeling it as the best approach for non-obstructive azoospermia: 1: Fine needle aspiration (FNA) mapping and directed TESE sperm retrievals have an equivalent rate of finding sperm in non-obstructive azoospermic men (Beliveau and Turek, 2011) 2: Fine needle aspiration and directed TESE sperm retrievals were published before microTESE was published (1997 vs 1999) and may in fact have inspired the idea of microTESE procedures 3: Sperm can be found in up to 29% of men using FNA Mapping AFTER failed microTESE procedures (Jarvis et al, 2018). The reverse of this however has not been shown. 4: The rate of surgically induced hypogonadism after failed microTESE procedures has been reported in up to 1/3 of cases whereas this complication is virtually unknown in FNA mapping cases (Herdon et al, 2022). For these reasons, my plea is that the Japanese Urology Assochiation change the mind to say that micro-TESE is the most popular technique used for surgical sperm retrieval but other techniques such as FNA Mapping and directed sperm retrieval may be equivalently good at detecting and retrieving sperm and that randomized trials need to be conducted to further strengthen this recommendation.