The implications of scrotal interference for the preservation of spermatogenesis in the management of testicular tumours

Abstract

Seminal analyses have been performed in 14 patients who have received radiation therapy following unilateral orchidectomy for testicular tumours. In patients receiving scrotal in addition to para-aortic and pelvic lymph node irradiation azoospermia occurred in 17 out 18 specimens examined, whereas in those patients not requiring scrotal irradiation, restoration of spermatogenesis occurred. The difference is a result of the increased dose of radiation received by the remaining testicle when the contralateral side of the scrotum is irradiated. Following scrotal aspiration, trans-scrotal biopsy or scrotal orchidectomy for testicular tumour, the scrotum becomes a possible site of recurrence and it should be electively irradiated. In order to give the patient the best chance of preserving fertility it is essential that scrotal interference in the management of testicular tumours must be avoided.

Bilateral Germ Cell Tumours of the Testis

“…Thus the mortality due to second tumour is approximately 1 % and considerably less than this for patients whose second tumours were Stage 1. There is thus no justification for treatment policies which electively treat the remaining testis, since the probability of a second tumour is low, the probability of cure of the second tumour if it arises is good, and the chance of the patient remaining fertile following nodal irradiation is good provided high cord ligation has been performed in the appropriate manner (Thomas et a/. , 1977).…”

Surveillance after Orchiectomy for Stage I Seminoma of the Testis

“…Although the immediate and longterm morbidity of the relatively modest radiation dose employed is low, there may be an increased risk of peptic ulceration (Hamilton et al, 1986) and non-testicular malignancy (Hay et al, 1984). Furthermore, the scattered radiation dose to the contralateral testis can result in temporary or permanent failure of spermatogenesis, particularly if the inguinal nodes and scrota1 sac are irradiated (Thomas et al, 1977).…”

Andrological aspects of testicular cancer

“…In general, semen analyses in groups of 7 to 86 selected patients with unilateral testicular cancer have shown that most of the patients had impaired semen quality before radio-and chemotherapy (Sandeman 1966;Haubrich & Harms 1973; Thomas et al 1977;Bracken & Smith 1980;Kuber et al 1980;FossP et al 1982;…”

“…Results obtained from groups of 8 to 25 selected patients with unilateral testicular cancer suggest, that this dose of scattered radiation induces temporary azoospermia in some patients. There is then a return to the pre-treatment sperm count within 1 to 2 years in a few patients, while a longer period for restoration is needed in the majority of patients (Sandeman 1966; Thomas et al 1977;Kuber et al 1980;Thachil et al 1981;Greiner 1982;Hahnetal. 1982).…”