Testicular sperm extraction after laparoscopic orchiectomy for bilateral postpubertal intra-abdominal cryptorchidism: What chance of sperm retrieval?

Cito, G.; Camera, P. Della; Innocenti, S. Degli; Coccia, Maria Elisabetta; Nesi, Gabriella; Cocci, Andrea; Morselli, Simone; Minervini, Andrea; Carini, Marco; Serni, M.; Gacci, Mauro; Natali, Alessandro

doi:10.1111/and.12936

Cited by 4 publications

(10 citation statements)

References 27 publications

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“…Although bilateral orchiectomy is often recommended and performed in men with bUDT, 50,51 our review has found testis preservation may afford adequate endogenous testosterone production and fertility potential. One study noted an inverse association with testosterone values and age at orchidopexy, suggesting surgery may prevent deterioration of hormone production 52 .…”

Section: Discussionmentioning

confidence: 86%

Fertility potential in adult men treated for uncorrected bilateral cryptorchidism: A systematic literature review and analysis of case reports

et al. 2021

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Objective Reports of adult orchidopexy for bilateral undescended testicles (bUDT) are sparse, and fertility outcomes are not well established. Our aim was to determine prognosis for restoration of spermatogenesis among adult men (≥18 years) undergoing orchidopexy for bUDT. Methods A systematic literature review, conforming to the PRISMA statement, was conducted using the PubMed/MEDLINE and EMBASE databases through March 2020 using search terms "adult” AND “bilateral orchidopexy" OR "bilateral cryptorchidism.” Relevant referenced articles from non‐indexed journal were identified by Google Scholar search and additionally included. Results Fifty‐seven publications including adult men with uncorrected bilateral UDTs were identified. Baseline semen analysis was reported in 157 men, all of whom demonstrated azoospermia. Testosterone values were reported in 82 cases and were normal in 89%. Germ cells could not be identified in 72.6% of histologic specimens from 62 testicles. Abdominal testicles more frequently lacked germ cells (90%, p = 0.038) on univariate analysis. Eleven cases identified ejaculated spermatozoa following adult bilateral orchidopexy (8 publications). Sperm extraction (TESE) during orchidopexy or orchiectomy was reported in 13 men without success. Delayed TESE (median 10 months) was performed in 22 persistently azoospermic men with success in 10 (45.5%), none of whom had abdominal testicles prior to orchidopexy. Six men experienced successful paternity via natural conception (3) or assisted reproduction (3). Conclusion Fertility is possible in adult men with inguinal bUDT following orchidopexy. Subsequent sperm retrieval may involve ejaculated specimens or delayed TESE. TESE performed prior to or at time of orchidopexy is unlikely to be of benefit.

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Section: Discussionmentioning

confidence: 86%

Fertility potential in adult men treated for uncorrected bilateral cryptorchidism: A systematic literature review and analysis of case reports

et al. 2021

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“…Refining the PubMed search further, using the terms "bilateral," "adult," "cryptorchidism," "orchidopexy," and "orchiectomy," 35 articles were found. After excluding articles in non-English languages, those that were published over 10 years ago, and those that reported on unilateral cryptorchid cases, pediatric cases, specific surgical techniques, or articles that were irrelevant, five articles were selected and reviewed [10][11][12][13][14].…”

Section: Discussionmentioning

confidence: 99%

A Contemporary Review of Cryptorchidism Management in Adults: A Rare Presentation of Bilateral Cryptorchidism Presenting as Pelvic Pain in an Adult Patient

Sholtes,

Tranthem,

Nakamura

et al. 2024

Cureus

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This case report presents a rare case of adult cryptorchidism, found incidentally in a 25-year-old gentleman who initially presented with abdominal and suprapubic pain and was successfully treated with staged orchidopexy. To our knowledge, to date, our case is the first published instance of bilateral cryptorchidism in an adult presenting with nonspecific suprapubic pain.Cryptorchidism is the most common genital abnormality in newborn boys, and due to its association with an increased risk of infertility and malignancy, current management involves surgical correction with orchidopexy by 12 to 18 months of life. Adult presentation of cryptorchidism is very unusual due to early intervention; therefore, bilateral cryptorchidism is even more rare. As a result, current guidelines do not address proper management for adult cryptorchidism.Therefore, after performing a thorough review of the literature on contemporary guidelines for cryptorchidism management, we aim to highlight our approach to management in this rare case of adult bilateral cryptorchidism. We suggest bilateral orchiectomy as the safest option, if the patient is amendable, or bilateral orchiopexy with long-term follow-up for testicular cancer. Although the American Urological Association guidelines recommend orchiectomy for postpubertal cryptorchid children, currently, no explicit guidelines exist for the preferred method of managing adult cryptorchidism. Due to the increased risk of infertility and testicular cancer with cryptorchidism, orchiectomy instead of orchiopexy may be the preferred surgical approach in some instances. Still, in the case of bilateral cryptorchidism, orchiectomy may not always be the most viable solution, making orchiopexy with long-term follow-up for testicular cancer the best option, such as in our case.

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“…Testicular sperm retrieval rates have been reported as 49.5 to 74% in azoospermic men with a history of cryptorchidism/orchidopexy. [3][4][5][6][7][8][9] Sperm retrieval rate has been significantly higher in azoospermic patients with a history of cryptorchidism than patients with different etiologies of non-obstructive azoospermia. fertilization, pregnancy, and live birth rates were similar between the two groups.…”

Section: Discussionmentioning

confidence: 99%

“…Testicular sperm retrieval rates have been reported as 49.5 to 74% in azoospermic men with a history of cryptorchidism or orchidopexy, and some studies have attempted to identify predictors for successful sperm retrieval in this population. [3][4][5][6][7][8][9] However, no study has reported risk factors that might predict sperm retrieval and pregnancy in azoospermic men with a history of cryptorchidism in a large series.…”

Section: Introductionmentioning

confidence: 99%

Fertility outcomes and predictors for successful sperm retrieval and pregnancy in 327 azoospermic men with a history of cryptorchidism who underwent microdissection testicular sperm extraction

et al. 2020

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Background Although few studies have reported fertility outcomes, no study has reported risk factors that might predict sperm retrieval and pregnancy in azoospermic men with a history of cryptorchidism in a large series. Objectives To investigate fertility outcomes and predictors for successful sperm retrieval and pregnancy in azoospermic men with a history of cryptorchidism who underwent microdissection testicular sperm extraction (mTESE). Materials and methods This retrospective observational study included 327 azoospermic men with a history of cryptorchidism who underwent mTESE. Fertility outcomes including sperm retrieval, fertilization rate, number of transferred embryos, pregnancy, miscarriage, and live birth rates were recorded. Results Sperm retrieval was observed in 172 (52.6%) of the patients. The mean fertilization, pregnancy, and live birth rates were 55.2%±20.5, 53.5%, and 44.8%, respectively. The sperm retrieval rate was significantly higher at the orchidopexy age of ≤ 9.5 years (70.8%) than the orchidopexy age of > 9.5 years (42.1%) (P = .000). Patients with total testicular volume of ≥ 13.75 mL had significantly higher sperm retrieval rate (65.2%) than the patients with total testicular volume of < 13.75 mL (45.5%) (P = .001). Patients with total testosterone level of ≥ 300.5 ng/dL had significantly higher sperm retrieval rate (65.6%) than the patients with total testosterone level of < 300.5 ng/dL (40.3%) (P = .000). Patients with follicle‐stimulating hormone (FSH) level of ≤ 17.25 mIU/ml had significantly higher sperm retrieval rate (72.3%) than the patients with FSH level of > 17.25 mIU/mL (44.4%) (P = .000). Younger male and female ages, and higher fertilization rates were the parameters that might predict pregnancy. Conclusions Infertile azoospermic men with a history of cryptorchidism have high sperm retrieval rate with mTESE. Patients who had orchidopexy at the age of ≤ 9.5 years, and having total testicular volumes of ≥ 13.75 mL with total testosterone level of > 300.5 ng/dL and FSH level of ≤ 17.25 mIU/mL have higher success rate for sperm retrieval.

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Testicular sperm extraction after laparoscopic orchiectomy for bilateral postpubertal intra-abdominal cryptorchidism: What chance of sperm retrieval?

Cited by 4 publications

References 27 publications

Fertility potential in adult men treated for uncorrected bilateral cryptorchidism: A systematic literature review and analysis of case reports

Fertility potential in adult men treated for uncorrected bilateral cryptorchidism: A systematic literature review and analysis of case reports

A Contemporary Review of Cryptorchidism Management in Adults: A Rare Presentation of Bilateral Cryptorchidism Presenting as Pelvic Pain in an Adult Patient

Fertility outcomes and predictors for successful sperm retrieval and pregnancy in 327 azoospermic men with a history of cryptorchidism who underwent microdissection testicular sperm extraction

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