V1396 MANAGEMENT OF FERTILITY IN ADULT INTRA-ABDOMINAL CRYPTORCHIDISM

Abstract

You have accessJournal of UrologyInfertility, Sexual Dysfunction, Trauma & Teaching Techniques1 Apr 2010V1396 MANAGEMENT OF FERTILITY IN ADULT INTRA-ABDOMINAL CRYPTORCHIDISM John Kefer, Kashif Siddiqi, Jihad Kaouk, and Edmund Sabanegh John KeferJohn Kefer More articles by this author , Kashif SiddiqiKashif Siddiqi More articles by this author , Jihad KaoukJihad Kaouk More articles by this author , and Edmund SabaneghEdmund Sabanegh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1067AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Adult cryptorchidism is a rare problem, but one that offers significant challenges towards management of both infertility and oncological risks. Options towards management include observation, orchidopexy, or orchiectomy with testicular sperm extraction (onco-TESE). This video demonstrates our technique for the management of a rare but significant disease process. METHODS A 22 year old male with a past surgical history of two previously failed attempts at bilateral orchidopexy (Fowler-Stevens). Relevant laboratory analysis included a testosterone of 770, FSH of 29, LH of 17, and semen analysis demonstrating normal volume azoospermia. Testicular tumor markers were also drawn, indicating Alpha fetoprotein (AFP) of 29 (normal <11), Beta human chorionic gonadotropin (BHCG) of 0.1, and lactate dehydrogenase (LDH) of 181. Based on the wishes of the patient and family, and after extensive counseling regarding the risks of testicular malignancy, the decision was made to undergo bilateral laparoscopic orchiectomy with ex vivo onco-TESE if normal testicular tissue was found. RESULTS Based on the location of the left and right testicles on preoperative MRI, we chose to perform bilateral procedures using separate port placements for left and right orchiectomy. Operative time was 95 minutes. Estimated blood loss was minimal. Surgical landmarks included identification of the surgical clips from the previous failed Fowler-Stevens procedures. Both testicles were identified and excised. No normal testicular tissue was identified on ex vivo onco-TESE. No sperm was isolated. A palpable solid mass was noted in the right testicle, and pathology revealed a mixed germ cell tumor. The patient was discharged on post-operative day 2 without complication. CONCLUSIONS Adult cryptorchidism is a rare problem, and requires management of fertility issues and oncologic risks. Treatment algorithms should include cryopreservation of testicular tissue when possible, and aggressive management of oncologic risks, including orchidopexy when possible to assist with testicular screening exams, or orchiectomy when orchidopexy is not possible. Cleveland, OH© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e539 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Kefer More articles by this author Kashif Siddiqi More articles by this author Jihad Kaouk More articles by this author Edmund Sabanegh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...