1
|
Hasirci E, Ceyhan E, Gultekin MH, Kayra MV, Kizilkan Y, Yildirim O, Altan M, Ure I, Cicek T, Sah C, Incekas C, Gul U, Turunc T. Parameters affecting the success rate of microscopic testicular sperm extraction in male patients with a solitary testis and non-obstructive azoospermia. Int Urol Nephrol 2024:10.1007/s11255-024-04074-w. [PMID: 38733502 DOI: 10.1007/s11255-024-04074-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024]
Abstract
PURPOSE We aimed to compare the success rate of spermatozoa retrieval through microscopic testicular sperm extraction (mTESE) in non-obstructive azoospermic (NOA) men with a solitary testis with that of mTESE in NOA men with bilateral testes and the parameters affecting these rates. METHODS A retrospective cross-sectional study of factors contributing to infertility in NOA patients with a solitary testis and men with bilateral testes was carried out. In this multicenter study, 74 patients with NOA with a solitary testis were matched with 74 patients with bilateral testes in terms of age, duration of infertility, and volume of the solitary testis from 2770 patients with NOA with bilateral testes. Hormonal parameters, presence of varicocele, history of varicocelectomy, history of undescended testis and karyotype analysis results were compared. RESULTS Spermatozoa were obtained from 40 (54.1%) patients with a solitary testis and 42 (56.76%) patients with bilateral testes. No differences were found regarding age, duration of infertility, or mean testicular volume between patients with a solitary testis and patients with bilateral testes. When serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels were compared regardless of sperm retrieval status, it was observed that both levels were greater in the group of patients with a solitary testis (p < 0.01). Patients with solitary and bilateral testes from whom spermatozoa were obtained had larger testes than those from whom spermatozoa could not be obtained (p < 0.05). Similarly, the serum levels of FSH and LH were significantly greater in patients with a solitary testis than in those with bilateral testes (p < 0.05). CONCLUSIONS To the best of our knowledge, this is the first study in the literature to evaluate the parameters that influence mTESE outcome in NOA patients with a solitary testis and NOA patients with bilateral testes. Greater testicular volume was found to positively affect spermatozoa retrieval for patients with a solitary testis. The higher levels of FSH and LH in patients with a solitary testis than in patients with bilateral testes of similar testicular volume may be due to a compensatory mechanism developed by the hypothalamic-pituitary-gonadal axis. The fact that these hormones are higher in patients with a solitary testis does not mean that the number of spermatozoa obtained through mTESE will be decreased.
Collapse
Affiliation(s)
- Eray Hasirci
- Faculty of Medicine, Department of Urology, Baskent University, Ankara, Turkey.
| | - Erman Ceyhan
- Faculty of Medicine, Department of Urology, Baskent University, Ankara, Turkey
| | - Mehmet Hamza Gultekin
- Cerrahpasa Faculty of Medicine, Department of Urology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mehmet Vehbi Kayra
- Faculty of Medicine, Department of Urology, Baskent University, Adana, Turkey
| | - Yalcin Kizilkan
- Department of Urology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Omer Yildirim
- Gelibolu Sehit Koray Onay State Hospital, Urology Clinic, Canakkale, Turkey
| | - Mesut Altan
- Faculty of Medicine, Department of Urology, Hacettepe University, Ankara, Turkey
| | - Iyimser Ure
- Faculty of Medicine, Department of Urology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Tufan Cicek
- Etlik Zubeyde Hanim Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Cem Sah
- Medline Hospital, Adana, Turkey
| | - Caner Incekas
- Faculty of Medicine, Department of Biostatistics, Baskent University, Ankara, Turkey
| | - Umit Gul
- Department of Urology, Private EPC Hospital, Adana, Turkey
| | | |
Collapse
|
2
|
Geada A, Jivanji D, Tennenbaum DM, Ghomeshi A, Reddy R, Sencaj M, Thomas J, Nassau DE, Ramasamy R. Long-term impact of commonly performed operations in pediatric urology on reproductive and sexual health. Ther Adv Urol 2024; 16:17562872241249083. [PMID: 38736900 PMCID: PMC11085008 DOI: 10.1177/17562872241249083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 03/28/2024] [Indexed: 05/14/2024] Open
Abstract
Introduction Sexual dysfunction is highly prevalent among men of reproductive age. Clinical practice guidelines have been established to assist providers in identification and education of patients who are at increased risk for infertility and sexual dysfunction with certain congenital and acquired urogenital disorders. The authors sought to review the reproductive and sexual health implications of treating common childhood urological conditions with commonly performed surgical procedures. Methods To ensure the inclusion of influential and highly regarded research, we prioritized citations from the most-frequently cited articles on our respective review topics. Our inclusion criteria considered studies with substantial sample sizes and rigorously designed methodologies. Several topics were reviewed, including penile chordee, hypospadias, posterior urethral valves, varicoceles, undescended testicles, and testicular torsion. Results For chordee, surgical plication or corporal grafting may be employed. Erectile function remains unaltered post-surgery, while penile length may decrease after repair, which may be avoided using dermal grafts. Hypospadias repair hinges on severity and availability of the urethral plate. Those who underwent hypospadias repair report decreased penile length, but sexual satisfaction, libido, and semen quality are comparable to controls. Posterior urethral valves are usually treated with valve ablation. While valve ablation and bladder neck incision have not been found to affect ejaculatory function, high degree of concurrent renal dysfunction related to nephrogenic and bladder dysfunction may impact semen parameters and erectile function. Regarding varicocele, earlier management has been associated with better long-term fertility outcomes, and surgical intervention is advisable if there is observable testicular atrophy. Earlier repair of undescended testicle with orchiopexy has been found to improve fertility rates as well as decrease malignancy rates. Unilateral orchiectomy for testicular torsion without the ability for salvage has been shown to have decreased semen parameters but unaffected fertility rates. Conclusion Infertility and sexual dysfunction are multivariable entities, with etiologies both congenital and acquired. At the same time, many common pediatric urology surgeries are performed to correct anatomic pathology that may lead to reproductive dysfunction in adulthood. This review highlights the need for diagnosis and management of pediatric urologic conditions as these conditions may impact long-term sexual function post-operatively.
Collapse
Affiliation(s)
| | | | | | - Armin Ghomeshi
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Raghuram Reddy
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | | | - Jamie Thomas
- Nova Southeastern University, Fort Lauderdale, FL, USA
| | | | - Ranjith Ramasamy
- Desai Sethi Urology Institute, University of Miami, 1150 NW 14th Street, Miami, FL 33136, USA
| |
Collapse
|
3
|
Spinelli C, Morelli G, Cito G, Bertocchini A, Ghionzoli M, Pucci A, Cocci A, Morganti R, Strambi S. Correlation between testicular volume and histological findings in children with unilateral cryptorchidism: Potential impact on future fertility. Urologia 2021; 89:292-297. [PMID: 33781144 DOI: 10.1177/03915603211004732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Our aim is to assess the correlation between testicular volume and histological findings in children with unilateral cryptorchidism. METHODS From September 2016 to August 2018, from 60 patients surgically treated for cryptorchidism, 45 children were enrolled in this single-center prospective study. Depending on the degree of testicular volume reduction, patients were divided into Group 1 with <20% reduction and Group 2 with reduction ⩾20%. Patients underwent unilateral orchidopexy and simultaneous biopsy of the undescended testis. Tanner stage was assigned. Tubular Fertility Index was measured. RESULTS Group 1 included 20 patients (44.4%) and Group 2 included 25 patients (55.5%). Mean age was 2.10 years (range 12 months-3.8 years) in Group 1 and 2.8 years (range 18 months-4.41 years) in Group 2. Although there is a positive correlation between testicular volume and Tubular Fertility Index, no significant association was found between groups (p-value = 0.29). Furthermore, histological patterns did not differ significantly among groups. CONCLUSIONS The degree of volume reduction in undescended testis does not seem to correlate significantly with the severity of histological changes that accompany cryptorchidism. Tubular Fertility Index could serve as objective tool for the assessment of future fertility.
Collapse
Affiliation(s)
- Claudio Spinelli
- Pediatric and Adolescent Surgery Division, Department of Medical, Molecular and Pathology Surgery, University of Pisa, Pisa, Italy
| | - Girolamo Morelli
- Department of Urology and Andrology Surgery, University of Pisa, Pisa, Italy
| | - Gianmartin Cito
- Department of Urology and Andrology Surgery, Careggi Hospital, University of Florence, Florence, Italy
| | - Alessia Bertocchini
- Pediatric and Adolescent Surgery Division, Department of Medical, Molecular and Pathology Surgery, University of Pisa, Pisa, Italy
| | - Marco Ghionzoli
- Pediatric and Adolescent Surgery Division, Department of Medical, Molecular and Pathology Surgery, University of Pisa, Pisa, Italy
| | - Angela Pucci
- Division of Pathology, University of Pisa, Pisa, Italy
| | - Andrea Cocci
- Department of Urology and Andrology Surgery, Careggi Hospital, University of Florence, Florence, Italy
| | - Riccardo Morganti
- Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy
| | - Silvia Strambi
- Pediatric and Adolescent Surgery Division, Department of Medical, Molecular and Pathology Surgery, University of Pisa, Pisa, Italy
| |
Collapse
|
4
|
Petrozzi A, Pallotti F, Pelloni M, Anzuini A, Radicioni AF, Lenzi A, Paoli D, Lombardo F. Inhibin B: are modified ranges needed for orchiectomised testicular cancer patients? Asian J Androl 2020; 21:332-336. [PMID: 30531061 PMCID: PMC6628744 DOI: 10.4103/aja.aja_93_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Inhibin B is a gonadal hormone that downregulates the pituitary production of follicle-stimulating hormone (FSH). In recent years, inhibin B has proved to be an excellent marker of spermatogenesis and even a predictive factor for the recovery of fertility in patients undergoing orchiectomy and antineoplastic treatments. We propose to study inhibin B levels in orchiectomised testicular cancer patients, in order to identify a minimum value representative of normal semen quality. This retrospective study evaluates hormonal and semen parameters of 290 normozoospermic patients attending the Laboratory of Seminology - Sperm Bank “Loredana Gandini” (Rome, Italy) for cryopreservation of seminal fluid following a diagnosis of testicular cancer (TC group) and 117 healthy, normozoospermic men as a control group (CTR group). The percentile distribution of gonadotropin and inhibin B values in the TC and CTR groups was analyzed. There was a statistically significant difference between the two groups in the levels of all hormones (P ≤ 0.001) and in all semen parameters (P < 0.05). About 20% of TC patients revealed inhibin B levels below the 5th percentile of CTR group, despite normozoospermia, and 31.4% had normal spermatogenesis in the presence of FSH values >95th percentile of CTR group. Orchiectomised patients for testicular cancer presented inhibin B levels lower than healthy patients, despite normozoospermia. Our study revealed the poor sensitivity of the current inhibin B reference range when applied to monorchidic patients, suggesting the need to establish more representative ranges to enable more appropriate counseling in relation to the patient's new endocrine condition.
Collapse
Affiliation(s)
- Alessandra Petrozzi
- Laboratory of Seminology, Sperm Bank "Loredana Gandini", Department of Experimental Medicine, Medical Pathophysiology Section, "Sapienza" University of Rome, Rome 00161, Italy
| | - Francesco Pallotti
- Laboratory of Seminology, Sperm Bank "Loredana Gandini", Department of Experimental Medicine, Medical Pathophysiology Section, "Sapienza" University of Rome, Rome 00161, Italy
| | - Marianna Pelloni
- Laboratory of Seminology, Sperm Bank "Loredana Gandini", Department of Experimental Medicine, Medical Pathophysiology Section, "Sapienza" University of Rome, Rome 00161, Italy
| | - Antonella Anzuini
- Hormone Laboratory, Department of Experimental Medicine, Medical Pathophysiology Section, "Sapienza" University of Rome, Rome 00161, Italy
| | - Antonio Francesco Radicioni
- Hormone Laboratory, Department of Experimental Medicine, Medical Pathophysiology Section, "Sapienza" University of Rome, Rome 00161, Italy
| | - Andrea Lenzi
- Laboratory of Seminology, Sperm Bank "Loredana Gandini", Department of Experimental Medicine, Medical Pathophysiology Section, "Sapienza" University of Rome, Rome 00161, Italy
| | - Donatella Paoli
- Laboratory of Seminology, Sperm Bank "Loredana Gandini", Department of Experimental Medicine, Medical Pathophysiology Section, "Sapienza" University of Rome, Rome 00161, Italy
| | - Francesco Lombardo
- Laboratory of Seminology, Sperm Bank "Loredana Gandini", Department of Experimental Medicine, Medical Pathophysiology Section, "Sapienza" University of Rome, Rome 00161, Italy
| |
Collapse
|
5
|
Rombaut C, Faes K, Goossens E. The Effect of a Unilateral Orchiectomy before Gonadotoxic Treatment on the Contralateral Testis in Adult and Prepubertal Rats. PLoS One 2016; 11:e0164922. [PMID: 27768736 PMCID: PMC5074494 DOI: 10.1371/journal.pone.0164922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 10/03/2016] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Previous studies have shown that the removal of one testis leads to a compensatory mechanism in the contralateral one, but this was species and age dependent. The aim of this study was to check whether this compensation would still occur after the combination of a unilateral orchiectomy and gonadotoxic treatment, since this resembles the clinical situation of patients who have to undergo highly toxic cancer treatment and therefore choose to cryopreserve a testicular biopsy for fertility restoration purposes. MATERIALS & METHODS Sprague Dawley rats underwent either unilateral orchiectomy, gonadotoxic busulfan treatment, the combination of both or served as fertile control. A comparison of the compensatory effects was made between adult and prepubertal treated rats. Mating experiments were performed, testosterone levels were followed-up, testicular weight was recorded and histology was analysed. RESULTS Adult treated rats were able to restore fertility spontaneously in all treatment groups. On the other hand, 30% of the rats that underwent a unilateral orchiectomy and gonadotoxic treatment at prepubertal age showed hampered spermatogenesis, low testosterone levels, decreased testicular weights and were not able to reproduce. CONCLUSION This study emphasizes the need of fertility preservation strategies in prepubertal patients before gonadotoxic interventions.
Collapse
Affiliation(s)
- Charlotte Rombaut
- Biology of the Testis, Research Laboratory for Reproduction, Genetics and Regenerative Medicine, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- * E-mail:
| | - Katrien Faes
- Biology of the Testis, Research Laboratory for Reproduction, Genetics and Regenerative Medicine, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ellen Goossens
- Biology of the Testis, Research Laboratory for Reproduction, Genetics and Regenerative Medicine, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| |
Collapse
|
6
|
Ateş F, Soydan H, Okçelik S, Çırakoğlu A, Yılmaz İ, Malkoç E, Karademir K. Clinical and histopathological results of the adult patients with unilateral cryptorchidism. Turk J Urol 2016; 42:74-9. [PMID: 27274891 PMCID: PMC4857921 DOI: 10.5152/tud.2016.47886] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 02/16/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the clinical and histopathological results of adult unilateral cryptorchidism patients. MATERIAL AND METHODS Data from adult unilateral cryptorchidism patients that underwent orchiectomy in our clinic between between January 2004 and March 2013 were retrospectively evaluated. Patients were divided into three groups as intra-abdominal, inguinal canal and superficial inguinal region according to the location of the undescended testes. Patients were also grouped according to their testicular volume (<4 cc, 4.1-12 cc, and >12 cc). Histopathology results of orchiectomy specimens were classified as follows: 1. Sertoli cells only, testicular atrophy and vanished testis (anorchia) 2. Hypospermatogenesis, and 3. Maturation arrest. Patients were grouped as normospermia, azoospermia and oligo/astheno/teratospermia groups according to semen analysis results. Correlations between testicular localization, testicular size, semen analysis and pathology results were evaluated. Incidental tumor detection rates were also calculated. RESULTS Two hundred and forty-four adult unilateral cryptorchidism patients underwent orchiectomy in our clinic. There was no a significant relationship between location of the testis and testicular pathology results (p=0.707). Most common semen analysis results was normospermia in patients with high testicular volume group however azoospermia and oligoasthenospermia observed commonly in patients with low testicular volume group. There was a significant relationship between testicular volume and semen analysis results (p=0.023). No significant relationship was observed between semen analysis and pathological results (p=0.929). After an evaluation of all factors with possible effects on the semen analysis results, only testicular volume (p=0.036) was found to have a significant impact. Only one case (0.4%) was incidentally diagnosed seminoma after a review of 233 patients with available histopathological results on record. CONCLUSION Adult unilateral cryptorchidism has a minimal effect on male fertility or even this effect can be overlooked. Low detection rates of incidental germ cell tumors also make an orchiectomy decision questionable in such cases.
Collapse
Affiliation(s)
- Ferhat Ateş
- Department of Urology, Gülhane Military Medical Academy Haydarpaşa Training Hospital, İstanbul, Turkey
| | - Hasan Soydan
- Department of Urology, Gülhane Military Medical Academy Haydarpaşa Training Hospital, İstanbul, Turkey
| | - Sezgin Okçelik
- Clinic of Urology, Beytepe Military Hospital, Ankara, Turkey
| | | | - İsmail Yılmaz
- Department of Pathology, Gülhane Military Medical Academy Haydarpaşa Training Hospital, İstanbul, Turkey
| | - Ercan Malkoç
- Department of Urology, Gülhane Military Medical Academy Haydarpaşa Training Hospital, İstanbul, Turkey
| | - Kenan Karademir
- Department of Urology, Gülhane Military Medical Academy Haydarpaşa Training Hospital, İstanbul, Turkey
| |
Collapse
|