An international survey of contemporary practices towards fertility assessment and preservation in patients undergoing radical inguinal orchidectomy for testicular cancer

Abstract

Objective: The study aims to assess current international clinician attitudes, practices and barriers towards fertility assessment and preservation in patients undergoing radical inguinal orchidectomy (RIO) for testicular cancer.

Materials and methods: An international online survey of urologists and urologists in training who perform RIO for testicular cancer was developed by the British Association of Urological Surgeons (BAUS) Sections of Andrology and Oncology and the British Urology Researchers in Surgical Training (BURST). The recruitment process used social media and the emailing lists of national urological societies. Responses were collected between 10/02/2021 and 31/05/2021 and stored using password-protected Research Electronic Data Capture (REDCap) database software. The primary outcome was the proportion of urologists who routinely offer semen cryopreservation prior to RIO. The study was reported according to the Checklist for Reporting Results of Internet E-Surveys platform.

Results: A total of 393 respondents took part in the online survey; of these, the majority were from the United Kingdom (65.9%), with the remaining international respondents (34.1%) from six different continents, which included 45 different countries. Of the respondents, 57.1% reported that they would routinely offer semen cryopreservation to all patients undergoing RIO for testicular cancer. In addition, 36.0% of urologists routinely performed pre-operative semen analysis, and 22.1% routinely performed pre-operative testicular serum hormone profile. Of the respondents, 14.4% performed expedited RIO within 48 h; 31.2% of respondents reported that they considered no delay to RIO to allow for semen cryopreservation to be acceptable.

Conclusions: A significant proportion of international urologists do not offer pre-operative fertility assessment and preservation in men undergoing RIO for testicular cancer. Surgery is performed in an expedited fashion within 1 week in the majority of patients. Urologists perceive there to be a lack of access and availability to fertility services, and that delay to RIO to allow for fertility preservation is often not acceptable.

Keywords: radical inguinal orchidectomy; semen cryopreservation; survey; testicular cancer.

FIGURE 1

Routine semen cryopreservation in patients undergoing radical inguinal orchidectomy for testicular cancer. *Specific indications: (i) patient had not had children before (fertility potential unknown); (ii) abnormal contralateral testis at clinical assessment pre‐operatively.

FIGURE 2

Respondent reasons for not offering semen cryopreservation prior to radical inguinal orchidectomy for testicular cancer (sub‐group analysis of those who do not offer cryopreservation, n = 41).

FIGURE 3

Pre‐operative semen analysis in patients undergoing radical inguinal orchidectomy for testicular cancer. *Specific indications: (i) If the patient has not had children before (ii) If there is an abnormal contralateral testis pre‐op.

FIGURE 4

Respondent reasons for not offering semen analysis prior to radical inguinal orchidectomy. (respondents allowed to select multiple options that were applicable; respondents; n = 85). *Specific indications: (i) If the patient has signs/symptoms of hypogonadism (ii) If there is an abnormal contralateral testis pre‐op.

FIGURE 5

Pre‐operative assessment of testicular hormone function in patients undergoing radical inguinal orchidectomy for testicular cancer.

FIGURE 6

Respondent reasons for not performing preoperative testicular hormone function assessment.

FIGURE 7

Scheduled timing of radical inguinal orchidectomy from time of diagnosis.