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Published on: February 6, 2012
Spermatogenesis in Testicles with Germ Cell Tumors
Igal Shpunt1, Dan Leibovici1, Sergey Ikher2
1Department of Urology, Kaplan Medical Center, Rehovot, Israel.
Background:
Almost 50% of patients with germ-cell tumors (GCT) are subfertile, and every step of the treatment may further impair fertility. As a result, sperm banking is often advised prior to radical orchiectomy. However, whether affected testes contribute to fertility is unclear.
Objectives:
To determine whether maximal tumor diameter (MTD) is correlated with ipsilateral fertility (IF) in patients treated for GCT.
Methods:
We reviewed medical charts for demographic and clinical data of patients with GCT who had undergone orchiectomy at our institution between 1999 and 2015. The extent of spermatogenesis was categorized into three groups: full spermatogenesis, hypospermatogenesis, and absence of spermatogenesis. The presence of mature spermatozoa in the epididymis tail was also assessed. We defined IF as the combination of full spermatogenesis in more than 100 tubules and the presence of mature spermatozoa in the epididymis tail. Mann-Whitney was applied to determine the correlation between MTD and IF.
Results:
Of 57 patients, IF was present in 28 (49%). Mean patient age was 32.8 years in patients with positive IF and 33.4 years those with negative IF. Seminoma was diagnosed in 46.4% of patients with positive IF and in 65.5% of patients with negative IF. Full spermatogenesis was observed in 33 patients (57.8%). In 48 (82.7%), mature epididymal spermatozoa were found. No correlation was found between MTD and IF.
Conclusions:
IF is present in almost half of the patients undergoing radical orchiectomy. Because IF cannot be predicted by MTD, routine pre-orchiectomy sperm banking is suggested.
Insights
Ipsilateral fertility (IF) is present in nearly half of patients undergoing radical orchiectomy for germ-cell tumors (GCT). Maximal tumor diameter (MTD) does not predict IF, supporting routine pre-orchiectomy sperm banking.
Area of Science:
- Reproductive Medicine
- Oncology
- Urology
Background:
- Germ-cell tumors (GCT) significantly impact male fertility, with subfertility affecting nearly 50% of patients.
- Fertility can be further compromised by GCT treatments, necessitating fertility preservation strategies like sperm banking before radical orchiectomy.
- The contribution of the affected testis to fertility remains uncertain, highlighting the need for predictive markers.
Purpose of the Study:
- To investigate the correlation between maximal tumor diameter (MTD) and ipsilateral fertility (IF) in patients treated for GCT.
- To assess the prevalence of ipsilateral fertility in patients undergoing orchiectomy for GCT.
Main Methods:
- Retrospective review of 57 GCT patients undergoing orchiectomy (1999-2015) for demographic and clinical data.
- Assessment of spermatogenesis (full, hypospermatogenesis, absence) and presence of mature epididymal spermatozoa.
- Definition of IF as full spermatogenesis (>100 tubules) and presence of mature epididymal spermatozoa; Mann-Whitney test used for MTD correlation analysis.
Main Results:
- Ipsilateral fertility (IF) was observed in 28 out of 57 patients (49%).
- No statistically significant correlation was found between maximal tumor diameter (MTD) and ipsilateral fertility (IF).
- Full spermatogenesis was present in 57.8% and mature epididymal spermatozoa in 82.7% of patients.
Conclusions:
- Ipsilateral fertility (IF) is present in approximately half of patients undergoing radical orchiectomy for GCT.
- Maximal tumor diameter (MTD) is not a reliable predictor of ipsilateral fertility (IF).
- Routine sperm banking prior to radical orchiectomy is recommended due to the unpredictability of fertility status.
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