Healthcare Tips

Fertility Preservation Following Torsion And Severe Ischemic Injury Of A Solitary Testis

June 10, 2017

UroToday - One interesting component of this case was that the patient was taking melantonin. We were never able to obtain the dose or the indication for this medication. In researching this subject we discovered a study in which melantonin was used to protect spermatogenesis in rats with injury from testicular ischemia and with reperfusion injury.1 It was a small study that concluded melatonin acts as an antioxidant helping to protect spermatogenesis during an ischemic-reperfusion injury. This same institution has produced several studies in rats that favor a protective effect of melatonin. 2,3,4 We were unable to find any information on melatonin in human cases.

An obstacle encountered during this patient's care was the discussion of sperm banking. This is not an easy subject to discuss due to several factors: the patient's embarrassment regarding the method of obtaining the specimen, parent's concerns of misuse of the specimen, and the issue of obtaining informed consent. As medicine advances and assisted reproduction technology progresses, these issues will need to be addressed.

Making physicians more cognizant of these issues and teaching healthcare professionals how to deal with them is paramount. In this regard, one must mention the pilot program for fertility preservation at Children's Hospital of Philadelphia. Gingsberg et al. describe in the protocol set up at their hospital for discussing such issues in a timely manner and parent's response to the protocol. 5 While most facilities will not have the resources to have this type of multidisciplinary team in place, it is not unreasonable for an institution, department, or practice to have a protocol available for just such an event.

References: 1 Yurtcu M, Abasiyanik A, Avunduk MC, Muhtaroglu S. Effects of melatonin on spermatogenesis and testicular ischemia-reperfusion injury after unilateral testicular torsion-detorsion. J Pediatr Surg 2008;43(10):1873-8.

2 Ozturk A, Baltaci AK, Mogulkoc R, Ozturk B. The effect of prophylactic melatonin administration on reperfusion damage in experimental testis ischemia-reperfusion. Neuro Endocrinol Lett 2003;24(3-4):170-2.

3 Abasiyanik A Dagdonderen L. Beneficial effects of melatonin compared with allopurinol in experimental testicular torsion. J Pediatr Surg 2004;39(8):1238-41.

4 Yurtcu M, Abasiyanik A, Bicer S, Avunduk MC. Efficacy of antioxidant treatment in the prevention of testicular atrophy in experimental testicular torsion. J Pediatr Surg 2009;44(9):1754-8.

5 Ginsberg JP, Carlson CA, Lin K, Hobbie WL, Wingo E, et al. An experimental protocol for fertility preservation in prepubertal boys recently diagnosed with cancer: a report of acceptability and safety. Hum Reprod 2010;25(1):37-41. Daniel Y. Woodruff, MD as part of Beyond the Abstract on UroToday. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations, etc., of their research by referencing the published abstract.

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