Effectiveness of, and Satisfaction with, a Microsurgical Testicular Sperm Extraction Knowledge and Skills Masterclass for a World-Wide Audience

Contributors: Edoardo Pozzi, MD (USA, Italy), Murat Dursun, MD

(Turkey), Mustafa Kadihasanoglu, MD (Turkey)

Commentary:

The study on microsurgical testicular sperm extraction (mTESE) training masterclass represents a significant milestone in addressing the critical need for specialized training in mTESE on a global scale (1). As the complexity of male factor infertility (MFI) management continues to row, so does the imperative for highly skilled practitioners capable of performing procedures like mTESE (2). This paper highlights the effectiveness of a novel online masterclass and underscores several key issues in contemporary andrology education and practice (1). First and foremost, the author’s innovative approach to delivering a comprehensive mTESE masterclass through a hybrid model deserves commendation (1). Combining didactic lectures with interactive case discussions has created a learning environment that bridges the gap between theory and practice - a crucial aspect often overlooked in traditional medical education (1). The Global Andrology Forum's (GAF) utilization of technology to reach a worldwide audience is particularly noteworthy, as it democratizes access to specialized knowledge that was previously confined to select institutions. The study's findings of broad, deep, and inclusive learning outcomes across various participant demographics are encouraging (1). However, they also reveal a concerning baseline deficiency in mTESE knowledge and skills among practicing andrologists (1). This gap in expertise, highlighted by the fact that 57% of participants had no prior mTESE training, raises important questions about the current state of andrology residency programs and continuing medical education globally (1). As such, 55% of the participants who stated that they had received mTESE training reported that they achieved this through the watched videos (1). This indicates the necessity of using standardized training materials (surgery videos) and a need for expanded practical training sessions (1). Moreover, the differential improvement observed among participants - with those having less experience and lower self-rated skills showing greater relative gains - points to the potential of such masterclasses in rapidly upskilling the andrology workforce (1). This is particularly crucial in addressing disparities in male infertility care across different healthcare settings and geographical regions.

While the authors should be commended for their rigorous evaluation of the masterclass's impact, future iterations could benefit from long-term follow-up to assess knowledge retention and, more importantly, the translation of learned skills into clinical practice. Additionally, the development of standardized, competency-based assessment tools for mTESE proficiency could further improve the value of such educational initiatives. The near-universal satisfaction reported by participants underscores the need for high-quality, accessible training in advanced andrological techniques. However, it also highlights a worrying lack of similar educational opportunities in the field. As such, this study serves as a call to action for professional societies and academic institutions to invest in developing and scaling up similar programs. In conclusion, the GAF authors have not only demonstrated the efficacy of their mTESE masterclass but have also outlined the urgent need for a paradigm shift in andrology education. Their work challenges the andrology community to reimagine how we train the next generation of specialists and upskill current practitioners. As we move forward, it will be crucial to build upon this model, integrating hands-on training components and engaging in emerging technologies like virtual reality to further enhance learning outcomes (3). The GAF's initiative marks an important step towards standardizing and elevating the quality of male infertility care worldwide. It is now incumbent upon the broader andrology community to answer this call and work collaboratively to ensure that every practitioner has access to the knowledge and skills necessary to offer patients the highest standard of care, regardless of their geographical location or practice setting.

References:

1. El Ansari W, Arafa M, Lock M, Shah R, Agarwal A. Effectiveness of, and satisfaction with, a microsurgical testicular sperm extraction knowledge and skills masterclass for a world-wide audience. World J Mens Health. 2024 Jul;42(3):574–86.

2. Schlegel PN. Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision. HumReprod. 1999 Jan 1;14(1):131–5.

3. Cacciamani GE, Chen A, Gill IS, Hung AJ. Artificial intelligence and urology: ethical considerations for urologists and patients. Nat Rev Urol. 2024 Jan;21(1):50–9.

Edoardo Pozzi, MD1,2,3,4, Murat Dursun, MD5,4, Mustafa Kadihasanoglu, MD6,4

1. Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL, USA;
2. University Vita-Salute San Raffaele, Milan, Italy;
3. Division of Experimental Oncology/Unit of Urology,
4. Global Andrology Forum, Moreland Hills, OH, USA; URI; IRCCS Ospedale San Raffaele, Milan, Italy;
5. University of Istanbul, Faculty of Medicine, Department of Urology, Section of Andrology, Istanbul, Turkey;
6. Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Urology, Istanbul, Türkiye

Authors ORCID:

Edoardo Pozzi: 0000-0002-0228-7039

Murat Dursun: 0000-0001-9115-7203

Mustafa Kadihasanoglu: 0000-0001-5109-5319

Corresponding Author:

Edoardo Pozzi, M.D.

Desai Sethi Urology Institute

Miller School of Medicine

University of Miami, Miami, FL, USA

Email: exp1710@miami.edu

Take Home Message

Contributing author: Ashok Agarwal, Director, Global Andrology Forum, Moreland Hills, OH, USA

Significant Knowledge Improvement: The masterclass markedly improved participants' mTESE knowledge and skills, with pre-quiz scores increasing from an average of 13.7 to 17.1 post-quiz. This improvement was consistent across various demographic and professional backgrounds, demonstrating the comprehensive and effective nature of the training.

Broad and Inclusive Impact: The enhancement in knowledge was broad, covering 19 out of 24 quiz questions, and inclusive, with all participants showing improvements regardless of their demographics or professional attributes. Notably, those with less prior experience or lower self-rated skills saw the most significant gains.

High Satisfaction: Participants reported extremely high satisfaction levels (98% to >99%) with the masterclass, highlighting the quality and relevance of the content, which included didactic lectures and case discussions led by international experts in male infertility management.

Global Andrology Forum's Effective Model: The success of this masterclass showcases the effectiveness of the Global Andrology Forum's model for online and hybrid educational activities. This model can be adopted by other organizations aiming to enhance specialist training in andrology and related fields.

Dr. Edoardo Pozzi works in Urology at Vita-Salute San Raffaele University, Milan, Italy. He graduated with honors and special mention from the English-language Medicine and Surgery program at the same university in 2019. During his final year of studies, he completed a research fellowship at the Andrology Department of University College London Hospital (UCLh) in London. After obtaining his license to practice clinically in the United States, Edoardo is doing a fellowship at the University of Miami, Desai Sethi Urology Institute. In Miami, he is involved in clinical/surgical activities and research in the uro-andrological field. He has authored over 90 scientific publications in indexed international journals, as well as six chapters in the uro-andrological field. He serves as Associate editor of the International Journal of Impotence Research (Springer Nature) and as a reviewer for several important scientific journals, including Human Reproduction, Fertility & Sterility, Andrology, and the Journal of Sexual Medicine.