Reproductive Urologist Preferences for Sperm Extraction in Congenital Bilateral Absence of the Vas Deferens

Among 51 reproductive urologists, no extraction technique dominated: testicular (39%), epididymal (29%), or a combination (31%)

Journal: Endocrine Practice | Published: 2026-02-18 | Type: Journal Article | PMID: 41720344 Authors: Passarelli R, Moore K, Islam R, Vij S, Leitner DV — Rutgers Robert Wood Johnson Medical School; UT Austin Dell Medical School Funding/COI: Funding not disclosed. No conflicts of interest.

Summary

Congenital bilateral absence of the vas deferens (CBAVD) causes obstructive azoospermia and accounts for roughly 1–2% of male infertility cases; it is also the predominant urological manifestation of cystic fibrosis mutations. This survey of 51 members of the Society for the Study of Male Reproduction found no consensus on which sperm extraction technique to use, with respondents splitting almost evenly across testicular sperm extraction (TESE), epididymal aspiration (PESA/MESA), and a combination. The takeaway from the paper's own conclusion: there are no clinical guidelines because there is almost no outcomes data.

Claims

• 39.2% of respondents preferred testicular extraction; 29.4% epididymal; 31.4% a combination
• Office-based extraction preferred by 56.9% vs. 41.2% operating room
• 68.6% would perform extraction only with an onsite andrology lab available
• Chi-square analysis found no significant association between onsite lab availability and extraction technique choice
• 90.2% would collect fertility labs on these patients
• 70.6% would not change their approach for a post-vasectomy patient seeking sperm retrieval over reversal, relative to a CBAVD patient

Study Quality

This is a preference survey, not an outcomes study — it cannot tell us which extraction technique produces better sperm yield, fertilization rates, or live birth rates. The survey was distributed to one professional society (Society for the Study of Male Reproduction), producing 51 responses. The response rate is not reported, so the representativeness of the sample is unknown. The clinical vignette was standardized (homozygous ΔF508 mutation, 24 cc bilateral testicular volume, normal epididymal heads), which is a reasonable methodological choice for eliciting practice preferences, but limits generalizability to patients outside that profile.

Chi-square analysis is appropriate for categorical survey data. That's the extent of the statistical ambition here, which is appropriate given the study design.

Red Flags

• N=51 from a single specialty society — this is not a nationally representative sample of urologists
• Response rate not reported — impossible to assess selection bias
• No outcomes data — preferences tell us what urologists do, not what works
• Funding not disclosed — minor concern for a survey study, but notable given the journal is an endocrinology publication (not standard for male reproductive urology)
• 51 responses split nearly three ways means each subgroup has ~15–20 respondents — too small to draw meaningful subgroup conclusions
• The paper was published in Endocrine Practice, not a urology-specific journal — unusual placement that may reflect limited enthusiasm from urology journals

Strengths

• Standardized clinical vignette reduces variability in respondent interpretation
• Covers a genuinely under-studied patient population (CBAVD with CF)
• Correctly identifies the absence of clinical guidelines as the core problem
• Reasonable that a preference survey precedes outcomes research — you need to know what practitioners are doing before you can study which approach is better

Verdict

This paper is a needs-assessment, not an answer. It documents that reproductive urologists lack consensus on CBAVD sperm extraction and — crucially — that no outcomes research exists to guide them. Those are useful facts. As a standalone publication, 51 survey responses with no response rate and no outcomes is thin, but it stakes out the problem clearly. Worth a skim if you're mapping gaps in CBAVD evidence; skip if you're looking for clinical guidance, because none is here.