BERKELEY, CA (UroToday.com) - In our recent paper, we described an emergency testicular sperm extraction (TESE) procedure which was aimed at preserving fertility in patients with testicular trauma and a history of contralateral testicular disease.
When a testicular trauma with rupture of the tunica albuginea occurs, it is almost impossible to achieve an exact overview of the fertility status of the patient. In particular, it is impossible to perform a spermiogram as well as very difficult to obtain some sperm to be cryopreserved. Some patients, such as monorchid or cryptorchid, deserve particular attention in case of contralateral trauma. In such an emergency setting, without the possibility to predict the functional outcome of the involved testis in terms of spermatogenesis, emergency TESE can offer a chance to preserve fertility.
In order to preserve seminiferous tubules we used a modified HTF medium with gentamicin–HEPES with human serum albumin supplementation, which is routinely used during TESE. Stored in this medium at 2° to 8°C, spermatozoa can survive for almost 24 hours, making it possible to perform emergency TESE even if immediate access to an andrology laboratory for the freezing procedure is unavailable.
Fertility is not the only issue in case of testicular trauma; in our case report we chose to spare the injured testis even if most of the parenchyma had to be resected. We made this decision in order to preserve, as much as possible, the hormonal function. A concern exists about the possibility that testicular repair could produce antisperm antibodies, but Kakudia et al. showed that early repair of testicular injury can help preserve fertility and hormonal function because subfertility does not appear to be immune mediated.
In conclusion, emergency TESE is a useful and safe procedure which can preserve fertility in patients with testicular trauma and contralateral testicular disease. Thus, in case of testicular trauma in patients with history of contralateral testicular diseases, we advise to proceed as follows:
- use ultrasound to detect albuginea ruptures and color-Doppler to evaluate vascularization;
- in case of albuginea rupture, take the patient to the operatory room immediately;
- before closing the albuginea, perform a TESE and put the seminiferous tubules in proper medium at 2-8°C, even if an andrology lab is not present in the hospital where the surgery is performed;
- take the seminiferous tubules to the laboratory as soon as possible, and ultimately, within 24 hours.
Franco Gadda, MD and Gabriele Cozzi, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Clinica Urologica I, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, Milan, Italy.