Is ex vivo microdissection testicular sperm extraction indicated for infertile men undergoing radical orchiectomy for testicular cancer Case report and literature review

Capsule:
Areas of spermatogenesis may be missed with conventional testicular sperm extraction (TESE) in azoospermic men with testicular cancer. Microdissection TESE should be offered at orchiectomy to maximize sperm retrieval.

Authors:
Nicholas Haddad, M.Sc., Khalid Al-Rabeeah, M.D., Ronald Onerheim, M.D., Armand Zini, M.D.

Volume 101, Issue 4, Pages 956-959

Abstract:

Objective:
To report a case of an infertile man with nonobstructive azoospermia who underwent simultaneous radical orchiectomy for testicular cancer and testicular sperm extraction (TESE) for preservation of fertility.

Design:
Case report and literature review.

Setting:
University teaching hospital.

Patient(s):
A couple being treated for infertility.

Intervention(s):
Radical orchiectomy with simultaneous TESE.

Main Outcome Measure(s):
Sperm retrieval, histologic evaluation of archived testicular pathology slides.

Result(s):
We retrieved 20 spermatozoa from the multiple random TESE samples obtained at radical orchiectomy. Histologic evaluation of the archived testicular pathology slides revealed that the testis contained several foci of active spermatogenesis, suggesting that a significantly greater number of spermatozoa would likely have been retrieved had a microdissection TESE been performed instead of the multiple TESEs.

Conclusion(s):
We propose that microdissection TESE should be considered the preferred sperm retrieval technique at the time of radical orchiectomy in men with coexistent nonobstructive azoospermia and testicular cancer.

  • These authors address some very important points with this case study:

    1. Men with testicular cancer often times have infertility issues
    2. Men with infertility issues have a higher risk for infertility
    3. NOA can often be present, therefore cryopreservation of ejaculated sperm is not an options
    4. Despite a good oncologic outcome is the primary goal for surgery, fertility preservation should also be highly considered
    5. Whatever little spermatogenesis may be present can be better found using MicroTESE techniques compared to conventional TESE.
    6. Significant coordination and cooperation between the operating urologic surgeon (if different from the fertility surgeon), fertility specialist, pathologist, and andrologist needs to take place to offer the patient the best diagnosis (margins, accurate diagnosis of pathology, tumor volume, etc.) and fertility preservation outcome (obtaining adequate sperm for cryopreservation).

    We must remember, however, that pathology waits for no one. In an insurance driven medical system (USA), coverage for malignancy is often unquestioned. However, fertility treatments are oftentimes excluded and therefore patients are responsible for the entire cost associated with fertility preservation. In the usual short time period from diagnosis to surgical removal of a suspected malignant testicle, financial arrangements may not be able to be finalized to fund the elective MicroTESE and sperm cryopreservation.

Translate »