Our Summary

This research paper reviews different methods for preserving fertility in patients who have experienced injuries to the testes that might affect their ability to have children. The researchers looked at medical studies and databases using keywords related to treatment, scrotal trauma, testicular injury, fertility, and fertility preservation. They focused on studies that reported on techniques for preserving fertility in cases where patients had lost one or both testes, or significant tissue from the testes due to trauma.

The researchers found two cases of testicular sperm extraction (TESE), eight cases of testicular replantation, and one case of sperm cryopreservation after injury. They found that viable sperm was present after surgery in five out of 11 patients. The most common reasons for failure of replantation were prolonged lack of blood supply and severe crush injury to the blood vessels of the testes. Both cases of TESE and the single case of cryopreservation were successful in obtaining viable sperm.

The researchers conclude that while cases of scrotal trauma that threaten fertility are rare, it’s important for doctors to consider fertility preservation whenever there’s a risk of significant loss of testicular tissue. They should offer fertility preservation options that are available in their area.

FAQs

  1. What are some common reasons for the failure of testicular replantation after injury?
  2. What are the options for preserving fertility in patients with fertility-threatening testicular injuries?
  3. What is the success rate of obtaining viable sperm after testicular sperm extraction or cryopreservation following testicular injury?

Doctor’s Tip

A helpful tip a doctor might tell a patient about testicular surgery is to discuss fertility preservation options before undergoing the procedure, especially if there is a risk of significant testicular tissue loss. Options such as testicular sperm extraction (TESE) or cryopreservation may be available and can help preserve the patient’s fertility for the future. It is important for patients to have an open and honest conversation with their doctor about their concerns and goals regarding fertility before undergoing surgery.

Suitable For

Patients who may be recommended testicular surgery include those with testicular trauma or injury that results in a significant loss of testicular parenchymal tissue, putting their fertility at risk. This may include patients who have experienced scrotal trauma or injury, testicular amputation, or other forms of testicular damage. In such cases, fertility-preserving techniques such as testicular sperm extraction (TESE), testicular replantation, or cryopreservation may be considered to help preserve fertility in these patients. It is important for urologists to consider fertility preservation options in any situation where there is a risk of significant testicular tissue loss.

Timeline

Before testicular surgery:

  1. Patient experiences scrotal trauma or injury that threatens fertility.
  2. Patient seeks medical attention and is evaluated by a urologist.
  3. Urologist discusses treatment options, including fertility preservation techniques.
  4. Patient undergoes surgery to address the testicular injury.

After testicular surgery:

  1. Patient may undergo testicular sperm extraction (TESE) to preserve fertility.
  2. Patient may undergo testicular replantation to restore testicular function.
  3. Patient may undergo cryopreservation of sperm for future fertility.
  4. Patient is monitored for the success of the surgery and fertility preservation techniques.
  5. Patient may have viable sperm present after surgery, indicating successful fertility preservation.
  6. Patient may face challenges such as prolonged ischaemic time or extensive crush injury to the testis, leading to potential failure of replantation.
  7. Urologist continues to monitor the patient’s fertility status and offers support as needed.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with the testicular surgery?
  2. How will the surgery affect my fertility and what options are available for preserving fertility?
  3. What is the success rate of fertility preserving techniques such as testicular sperm extraction (TESE) or cryopreservation after testicular injury?
  4. What is the expected recovery time and post-operative care for testicular surgery?
  5. Will I need any additional treatments or follow-up care after the surgery?
  6. How soon after the surgery can I resume normal activities, including sexual activity?
  7. Are there any lifestyle changes or restrictions I should be aware of following the surgery?
  8. How will the surgery impact my overall health and well-being in the long term?
  9. Are there any alternative treatment options available for my condition?
  10. Can you provide me with more information or resources about testicular surgery and fertility preservation?

Reference

Authors: Starmer BZ, Baird A, Lucky MA. Journal: BJU Int. 2018 Mar;121(3):466-471. doi: 10.1111/bju.14084. Epub 2017 Dec 10. PMID: 29164757