The Outcomes of Onco-Testis Sperm Extraction at the Time of Radical Orchiectomy

Objective: To evaluate outcomes of onco-testis sperm extraction (TESE) and to define potential predictors of successful surgical sperm retrieval (SSR).

Methods: For this study, we examined all men (i) diagnosed with a testicular mass, (ii) who had azoospermia, and (iii) who underwent a radical orchiectomy and onco-TESE. Our institutional database of testicular cancer (TCA) patients was reviewed. Demographics, baseline endocrine and oncological characteristics, and treatments received were recorded. The onco-TESE Technique was performed at the time of radical orchiectomy before the specimen was sent for formal histopathological assessment. Onco-TESE was considered successful if viable sperm was found. Logistic regression assessments were performed to evaluate predictors of successful onco-TESE.

Results: Thirty-eight men with a median age of 35 were included in the analysis. Median baseline total testosterone, LH, and FSH levels were 419ng/dL, 10.9mU/mL, and 27mU/mL, respectively. The median pre-TESE testicular volume was 11 mL. Of men who underwent radical orchiectomy, 58% had unilateral tumors at the time of the procedure. 42% had bilateral tumors, which were synchronous in 25%, and asynchronous tumors in 75%. Pathologically, 76% had germ cell tumor (83% had pure seminoma, and 17% had mixed germ cell tumor). At onco-TESE, 24% of the patients had successful SSR. No variables had a statistically significant association with successful SSR.

Conclusion: Onco-TESE represents a useful option for testis cancer patients who wish for future paternity, with a quarter of such patients having sperm found.