K Suzuki1, T Shin2, Y Shimomura2, T Iwahata2, H Okada2. 1. Department of Urology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama 343-8555, Japan suzukike@dokkyomed.ac.jp. 2. Department of Urology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama 343-8555, Japan.
Abstract
STUDY QUESTION: What are the factors that might indicate a greater likelihood of success in oncologic testicular sperm extraction (onco-TESE)? SUMMARY ANSWER: Smaller tumor diameter and greater noncancerous testicular tissue width (NCTW) are positive predictors of spermatogenesis in patients with testicular germ cell tumors (TGCTs). WHAT IS KNOWN ALREADY: Onco-TESE is a key modality for fertility preservation in cases of inadequate pretreatment sperm collection and azoospermic men with testicular cancer. TGCTs are known to reduce sperm quality such that ∼ 10% of these patients are azoospermic, making surgical TESE at the same time as orchiectomy their only means of fertility preservation. STUDY DESIGN, SIZE, DURATION: This study is a retrospective analysis performed in a single university hospital from 2002 to 2014. PARTICIPANTS/MATERIALS, SETTING, METHODS: Participants were 102 male patients (104 testes) who underwent inguinal orchiectomy and were diagnosed with a germinoma. In each specimen, the Johnsen Score Count (JSC) in seminiferous tubules at each established distance from the tumor margin (1, 2.5, 5, 7.5, 10 and 12.5 mm) was determined. We analyzed the relations between age, tumor histopathologic type, tumor size (maximum diameter), distance from the tumor, non-tumor tissue width and JSC. MAIN RESULTS AND THE ROLE OF CHANCE: The 104 specimens consisted of 78 seminomas and 26 non-seminomatous TGCTs. The mean ± SD JSC was 4.7 ± 2.4 in seminomas and 3.9 ± 2.5 in non-seminomatous germ cell tumors, with no significant difference between the two subtypes. Single regression analysis showed that tumor diameter was significantly negatively correlated with spermatogenesis (RC = -0.422, P < 0.001). Multiple linear regression analysis also showed that tumor diameter had a negative influence on spermatogenesis (RC = -0.437, P < 0.001). The greater the distance the seminiferous tubules from the tumor, the better the preservation of spermatogenesis. Mature spermatozoa were identified in 93.0% of patients with a NCTW ≥ 7.5 mm and in 41.3% of those with NCTW < 7.5 mm (P < 0.001). LIMITATIONS, REASONS FOR CAUTION: Study data were obtained retrospectively, which might have affected the quality of data. We were unable to compare spermatogenesis determined using preoperative seminograms with that determined histopathologically. It was not possible to evaluate spermatogenesis in the total volume of noncancerous testicular tissue. WIDER IMPLICATIONS OF THE FINDINGS: When Onco-TESE is conducted at sites distant from tumors, the rate of sperm extraction is high and contamination by tumor cells can be prevented. By measuring non-testicular cancerous margin before the operation, the possibility of sperm extraction can be predicted and biopsy of the contralateral testis can be considered based on the results.
STUDY QUESTION: What are the factors that might indicate a greater likelihood of success in oncologic testicular sperm extraction (onco-TESE)? SUMMARY ANSWER: Smaller tumor diameter and greater noncancerous testicular tissue width (NCTW) are positive predictors of spermatogenesis in patients with testicular germ cell tumors (TGCTs). WHAT IS KNOWN ALREADY: Onco-TESE is a key modality for fertility preservation in cases of inadequate pretreatment sperm collection and azoospermic men with testicular cancer. TGCTs are known to reduce sperm quality such that ∼ 10% of these patients are azoospermic, making surgical TESE at the same time as orchiectomy their only means of fertility preservation. STUDY DESIGN, SIZE, DURATION: This study is a retrospective analysis performed in a single university hospital from 2002 to 2014. PARTICIPANTS/MATERIALS, SETTING, METHODS:Participants were 102 male patients (104 testes) who underwent inguinal orchiectomy and were diagnosed with a germinoma. In each specimen, the Johnsen Score Count (JSC) in seminiferous tubules at each established distance from the tumor margin (1, 2.5, 5, 7.5, 10 and 12.5 mm) was determined. We analyzed the relations between age, tumor histopathologic type, tumor size (maximum diameter), distance from the tumor, non-tumor tissue width and JSC. MAIN RESULTS AND THE ROLE OF CHANCE: The 104 specimens consisted of 78 seminomas and 26 non-seminomatous TGCTs. The mean ± SD JSC was 4.7 ± 2.4 in seminomas and 3.9 ± 2.5 in non-seminomatous germ cell tumors, with no significant difference between the two subtypes. Single regression analysis showed that tumor diameter was significantly negatively correlated with spermatogenesis (RC = -0.422, P < 0.001). Multiple linear regression analysis also showed that tumor diameter had a negative influence on spermatogenesis (RC = -0.437, P < 0.001). The greater the distance the seminiferous tubules from the tumor, the better the preservation of spermatogenesis. Mature spermatozoa were identified in 93.0% of patients with a NCTW ≥ 7.5 mm and in 41.3% of those with NCTW < 7.5 mm (P < 0.001). LIMITATIONS, REASONS FOR CAUTION: Study data were obtained retrospectively, which might have affected the quality of data. We were unable to compare spermatogenesis determined using preoperative seminograms with that determined histopathologically. It was not possible to evaluate spermatogenesis in the total volume of noncancerous testicular tissue. WIDER IMPLICATIONS OF THE FINDINGS: When Onco-TESE is conducted at sites distant from tumors, the rate of sperm extraction is high and contamination by tumor cells can be prevented. By measuring non-testicular cancerous margin before the operation, the possibility of sperm extraction can be predicted and biopsy of the contralateral testis can be considered based on the results.
Authors: Kilian Vomstein; Elisabeth Reiser; Germar M Pinggera; Peter Toerzsoek; Susanne Deininger; Thomas Kriesche; Wolfgang Biasio; Lukas Lusuardi; Bettina Toth Journal: Asian J Androl Date: 2021 Sep-Oct Impact factor: 3.285