Can You Have a Baby After Prostate Removal

Case Report | Open up Access

Republic of chad Reichard, Edmund S. Sabanegh, J. Stephen Jones, Khaled Fareed , "Spermaturia after Radical Prostatectomy: Is Surgical Preservation of Fertility Possible?", Case Reports in Urology, vol. 2013 , Article ID 124715 , three pages , 2013 . https://doi.org/10.1155/2013/124715

Spermaturia after Radical Prostatectomy: Is Surgical Preservation of Fertility Possible?

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Chad Reichard ,ⁱ Edmund South. Sabanegh ,¹ J. Stephen Jones ,^ane and Khaled Fareed¹

¹ Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Artery, Q10-one, Cleveland, OH 44195, The states

Bookish Editor: S. J. Hong

Received 18 January 2013

Accepted 12 Mar 2013

Published 07 Apr 2013

Ease of sperm retrieval has not been previously described as a goal for patients undergoing radical prostatectomy for prostate cancer; notwithstanding preservation of fertility is a known concern for some younger prostate cancer patients. We present the first known case of a patient with postejaculatory spermaturia following robotic assisted radical prostatectomy. We hypothesize that this is due to fistula germination betwixt the vas deferens and the urinary tract.

1. Introduction

The mean age at diagnosis of prostate cancer from 2005 to 2009 was 67 years of historic period [1]. For the majority of patients in this age grouping, maintaining fertility is not a high priority. Cancer control, urinary continence, and erectile function are the more concerning outcomes for patients [ii]. Nonetheless, at that place are reports of younger men with prostate cancer undergoing sperm cryopreservation and percutaneous epididymal sperm extraction (PESA) for intracytoplasmic sperm injection (ICSI) [3–5]. Patients with low or intermediate risk disease and thus a more favorable prognosis of cure from surgery alone might benefit from an attempt at concomitant preservation of continuity of the vas with the urinary tract in gild to facilitate ease of sperm retrieval for future efforts of formulation.

2. Case Report

The patient was a 62-yr-old human referred for urologic evaluation subsequently new onset nocturia, frequency, and urgency with a PSA of 3.54 ng/mL. Four years prior to evaluation PSA was 2.38 ng/mL and eight years prior to it was ane.four ng/mL. He denied hematuria or history of urolithiasis. By medical history was significant for hypertension, hyperlipidemia, and coronary artery disease. IPSS was 22; Quality of Life Score was iii. SHIM was 21. He was married with two children. The patient afterwards underwent transrectal ultrasound guided (TRUS) biopsy of the prostate. Pathology revealed Gleason prostate cancer in 1 of 20 cores with 5–10% of cadre involvement. The patient was counseled on the various handling options for low risk, clinically localized prostate cancer, and elected to continue with robotic assisted laparoscopic prostatectomy in September 2010. In that location was no clinically significant deviation from the usual operative technique; however, during posterior bladder neck division, the seminal vesicles and vasa deferentia were found to be particularly adherent to the rectal serosa and were taken in piecemeal manner.

Concluding pathology revealed pT2c, Gleason prostatic adenocarcinoma with negative surgical margins. Seminal vesicles were nowadays in the specimen and were negative for tumor. Two months postoperatively, he developed some correct testicular discomfort and on test the right epididymis was enlarged and tender. Microscopic urinalysis revealed xv–20 rbc/hpf, five–10 wbc/hpf, no bacteria, and no evidence of sperm. Urine culture had insignificant growth. He was empirically treated with ciprofloxacin for epididymitis which resolved. At 18 months postoperatively, routine urinalysis was heme positive and microscopy revealed 1–iii nonmotile sperm per loftier powered field (hpf) (Figure 1). The patient denied any new urinary symptoms or other complaints. PSA remained undetectable. Subsequent postejaculatory urinalysis one calendar week later on revealed 10–12 nonmotile sperm/hpf.

3. Discussion

While data on fertility in cancer patients is prevalent in the literature, a Medline search using "fertility and prostatectomy" as well as more than specific terms "spermaturia and prostatectomy" did not yield any results that described similar findings to the aforementioned case.

While this patient does not have motile sperm and thus does not have proven preservation of fertility, the fact that sperm are nowadays in the postejaculation urine demonstrates a patent communication between the vas and the urinary tract. Because of the relative acidity of urine versus semen, it is not unexpected that the sperm is immotile in the urinary environment. Sperm move might be preserved past concurrent urinary alkalinization equally is performed for fertility preservation in the setting of neurogenic based retrograde ejaculation. Whether the presumed fistulous tract volition remain patent, with continued passage of sperm, is unknown. In addition, in that location was no recent preoperative semen assay; thus information technology is not known for sure whether oligoasthenospermia was present prior to surgery or is solely related to the surgically contradistinct anatomy.

A review of a cryopreservation database past Williams IV et. al. demonstrated that with the exception of testicular cancer, men with near types of cancer have pretreatment semen parameters in the fertile range for density and in the intermediate range for motion. Half-dozen per centum of the 717 semen samples from 409 men were from men with prostate cancer with a mean age at cryopreservation of 51.6 (range: 38.7–65.8) [5]. These data, in addition to the patient'southward prior fertility, make information technology unlikely that the oligoasthenospermia is solely due to preexisting pretesticular or testicular aberration. Further followup of this patient is needed to run across if sperm quality improves with time, or if azoospermia ensues. With the current data, it seems that any attempt to attain normospermia by purposeful incorporation of the vas in the vesicourethral anastomosis during prostatectomy represents a formidable technical challenge.

The morbidity of the event presented in this instance is not clear. There may be a psychological detriment to informing patients who do non desire fertility that at that place are sperm in the postejaculatory urine fifty-fifty in spite of the fact that they are nonmotile and unlikely to cause pregnancy. This patient was monogamous with his postmenopausal wife, so he was not concerned that he could have even a remote possibility of fertility.

The current agreement of the pathophysiology of epididymo-orchitis in older men relates to seeding from urinary pathogens [6]. Thus there might exist a theoretical increase in the hazard of epididymo-orchitis in these patients since urine may more freely reflux into the vas, analogously to the phenomenon of urethroejaculatory duct reflux described in some children with epididymo-orchitis [seven, 8]. The take chances would well-nigh probable exist lower in a patient that returns to normal voiding habits as this patient did, without stasis as a risk factor for urinary tract infection. However, this might be a greater consideration in patients that develop high pressure level voiding, due to stricture of the bladder neck with associated retention, and stasis. The fact that this patient had mild epididymo-orchitis at 2 months postoperatively raises clinical suspicion; all the same, this was a single episode in ii years of followup.

four. Conclusions

This case reports, to our knowledge, a previously undescribed finding of postejaculatory spermaturia in a patient status after robotic assisted laparoscopic radical prostatectomy. This finding is hypothesized to be due to germination of vasovesical fistula. We hypothesize that with future modifications of operative techniques, it may exist possible to provide patients that desire to maintain fertility with a method to facilitate ease of sperm retrieval for artificial reproductive methods. However these techniques might be express past high master failure rates and potential added morbidity such equally increased risk for epididymo-orchitis. In addition, it is unlikely success rates would be high enough to preclude the need for current methods of preoperative fertility preservation (i.e. sperm cryopreservation).

References

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Copyright

Copyright © 2013 Chad Reichard et al. This is an open access commodity distributed under the Creative Commons Attribution License, which permits unrestricted employ, distribution, and reproduction in whatever medium, provided the original work is properly cited.

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Source: https://www.hindawi.com/journals/criu/2013/124715/

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