Adolescent urology

Abstract

Reproductive health risks and clinician practices with gender diverse adolescents and young adults. Quinn GP, Tishelman AC, Chen D, Nahata L., Andrology. 2021 May 4., https://doi.org/10.1111/andr.13026Editorial comment: As more adolescents and young adults (AYA) with gender dysphoria seek medical and surgical therapy for gender affirmation, clinicians must become more aware of potential effects of therapy on reproductive health and sexual health. The review summarizes practices and challenges related to reproductive and sexual health. Reproductive health goals include those related to parenthood and satisfying sexual experiences. Reproductive health risks include those related to puberty blockers and potential fertility impairment. Risky sexual behaviors may have significant health effects such as STI and AYA may benefit from HIV preexposure prophylaxis and HPV vaccines. Sexual assault and interpersonal violence are other areas of risk, particularly among people of color. Comprehensive reproductive health counseling is recommended for transgendered AYA. Dedicated training for providers to improve communication is necessary.Take-home message: Discussions related to reproductive and sexual health in transgendered AYA are clinically and ethically complex. Patient and clinician education is necessary. We also need to better understand the reproductive health goals of the individual and the risks associated with therapies. Clinical research is certainly warranted to optimize care.Testicular microlithiasis on scrotal ultrasound in 4850 young men from the general population: associations with semen quality. Anvari Aria S, Nordström Joensen U, Bang AK, Priskorn L, Nordkap L, Andersson AM, Jørgensen N. Andrology. 2020 Nov; 8 (6):1736–1743. doi: 10.1111/andr.12854Editorial comment: Testicular microlithiasis (TM) and its effect on semen quality is controversial. Over a 14-year period, the authors invited 4850 Danish men being considered for compulsory military to participate in a study including a physical examination, including testicular ultrasonography, semen sample and blood samples for follicle-stimulating hormone, luteinizing hormone, sex hormone-binding globulin, testosterone and inhibin B. Questions regarding previous and prior diseases and lifestyle factors were asked. Semen quality including sperm concentration, motility and morphology were evaluated.TM was identified in 53 (1.1%), unilateral in 19 (36%) and bilateral in 34 (64%). The prevalence in this study was lower than prior studies including those of American (5.6%) and Turkish (2.4%) army recruits. Cryptorchidism was associated with the presence of TM. Lower sperm concentration and total sperm counts were lower in men with bilateral TM but not unilateral TM. There was no significant difference testosterone levels or hormones associated with reproduction.Take-home message: TM is rare but is more common in men with a history of cryptorchidism. Men with bilateral TM may be counseled on the potential for poor semen parameters. Evaluation of reproductive hormones is not warranted.Fertility preservation for male patients with childhood, adolescent, and young adult cancer: recommendations from the PanCareLIFE Consortium and the International Late Effects of Childhood Cancer Guideline Harmonization Group. Mulder RL, Font-Gonzalez A, Green DM, Loeffen EAH, Hudson MM, Loonen J, et al; PanCareLIFE Consortium. Lancet Oncol. 2021 Feb;22(2):e57-e67. doi: 10.1016/S1470-2045(20)30582-9.Editorial comment: Therapies for cancer in children, adolescents and young adults (CAYA) including chemotherapy, radiotherapy and abdominal surgeries may lead to hypogonadism, infertility and injury to reproductive organs.Given improvements in survival rates for CAYA with cancer, attention to future fertility has become increasingly important.In order to help optimize fertility preservation and develop a global consensus,the authors performed a systematic review and make recommendations for fertility preservation. These recommendations are proposed by the European Union-funded research project PanCareLIFE in collaboration with the International Late Effects of Childhood Cancer Guideline Harmonization Group.The panel agreed and recommended that all patients with cancer and their families have the right to be informed about their potential risk for infertility. The panel agrees that a knowledgeable provider, rather than a provider of a specific discipline, should assume the role of fertility counselor. Fertility preservation should be discussed in those that will be treated with alkylating agents of any dose (high-quality evidence), testicular radiotherapy (moderate-quality evidence), stem cell transplant (expert opinion), cisplatin (low-quality evidence), orchiectomy (expert opinion), or cranial radiotherapy (very low-quality evidence), or a combination. The panel proceeds to evaluate evidence for multiple, specific methods of fertility preservation and encourage discussions about the cost, risk, benefits, and logistics that are associated with fertility preservation to help families make appropriate decisions.Knowledge gaps and directions for future research are presented.Take-home message: Attention to fertility preservation in CAYA requires careful attention to the specific cancer being treated, treatment modality and techniques available.