Iatrogenic effects of radical cancer surgery on male fertility

[madman]

Iatrogenic causes of male infertility can include medications, chemotherapy, radiation, and surgery. In this review, we discuss commonly performed urologic cancer surgeries and nonurologic surgeries that harbor a high risk of iatrogenic infertility. These include radical prostatectomy, radical cystectomy, retroperitoneal lymph node dissection, pelvic colon surgery, and anterior spine surgery. In addition, we review the anatomy and surgical strategies that help to reduce the risks of infertility. With an increase in life expectancy and improvements in fertility preservation, it is important to properly counsel patients about the risks of infertility and provides options for fertility preservation before surgery.




The impact of cancer treatments on fertility is increasingly significant as cancer-related mortality continues to decline in the United States. In a survey regarding patients’ experiences of cancer-related infertility, only 60% of men were counseled about infertility as a side effect of cancer treatments, and only 51% were offered sperm banking (1). The lack of information was noted to be the most common reason for failing to bank sperm. The 2018 American Society of Clinical Oncology update on fertility preservation recommended that healthcare providers address the possibility of infertility as early as possible before starting cancer treatments and should refer patients who are interested in fertility preservation to reproductive specialists (2). It is significant for healthcare providers to be aware of iatrogenic effects of cancer treatments on fertility and provide an early and informed discussion with the patient. In the management of solid organ cancers, surgical resection remains the cornerstone for primary treatment. However, iatrogenic effects of surgeries on male fertility are common. For example, radical prostatectomy irreversibly alters the anatomy of the ejaculatory system and causes obstructive azoospermia. Sperm banking can be the most significant and reliable option to preserve fertility in patients before surgical management. Informed counseling can help patients preserve fertility and improve their quality of life in cancer survivorship. In this review, we discuss the common iatrogenic causes of infertility related to surgeries performed for cancer, including radical prostatectomy, radical cystectomy, retroperitoneal lymph node dissection (RPLND), pelvic colon surgery, and anterior spine surgery.




*RADICAL PROSTATECTOMY/ CYSTECTOMY: OBSTRUCTIVE AZOOSPERMIA

*RETROPERITONEAL LYMPH NODE DISSECTION: ANEJACULATION/RETROGRADE EJACULATION

*PELVIC COLON SURGERY: ANEJACULATION/ RETROGRADE EJACULATION

*ANTERIOR LUMBAR SPINE SURGERY: ANEJACULATION/RETROGRADE EJACULATION




In conclusion, several cancer surgeries carry the risk of impairing fertility. For men who are to receive cancer treatment, adequate informed counseling should be provided, and sperm cryopreservation should be offered. With the development of new technologies and innovations in surgical techniques, autonomic nerve-sparing surgeries are feasible with reasonably improved functional outcomes. However, careful patient selection is paramount, and adequate oncologic source control should not be compromised.