Positive TESE after Orchidopexy of Bilateral Abdominal Cryptorchidismin an Adult: A Case Report

1. Abstract Background: Undescended test is isacongenital anomaly that is usually discovered in childhood and undergoes orchidopexy. Undiscovered adult patient with this condition usually undergoes orchiectomy due to atrophy of the testis and a high risk of malignancy. Retrieving vital germ cells from adult bilateral non-intra-abdominal cryptorchidism is a very rare finding and the incidenceforintra-abdominalisevenrarer.We was repotting the case of bilateral intra-abdominal cryptorchidism with positive TEAE duringorchidopexy.We consider this is a first case was reported in English literate review

Case Presentation: a 37-year male came to our clinic complaining of infertility after eight years of marid.Examination showed absent of bilateral testis, and the ultrasound showed intra-abdominal testis. His wife underwent an assessment that was normal for contributing female factors. A laparoscopic orchidopexy was done; one testis were fixed to the scrotum, and the secondwasfixedtotheinguinal.ATESEwasobtainedduringthe operation and showed viable sperm.

Conclusion: Our Aim is to report successful sperm extractionusingTESEfromintra-abdominalpost-pubertalundescended testis

Keywords: Undescended testis; Orchidopexy; TESE

2. Introduction Cryptorchidism complicates about 1% of full-term pregnancies, but the riskincreases to 3-30% inpretermdeliveries. The condition increases the risk of infertility and testicular cancer if left untreated. Most cases are discovered early, and the treatment of choice is orchidopexy at the age of 1-2 years. Most experts recommendorchiectomyinadults.However,sometimesorchidopexy andTESEisanoptionthatcanbeconsideredinanadultpatientto retrieve viable spermatozoa and preserve fertility [1].

3. Case Presentation A 37-year-old male, presented to our clinic with bilateral cryptorchidismseeking fertility, he had been marriedfor 8 years, they have been trying to conceive since then, he has normal sexual desire, and he can maintain satisfactory erection and normal ejaculation.Hiswifehadundergoneacompletegynaecologicalassessment and she was found normal. On examination there were no palpable testicles in the scrotum or inguinal region and his semen analysis results showed Azoospermia, normal tumor marker and hormonalanalysis,ultrasoundscanshowedthatbothtesticleinthe pelvicregionjustanteriortotheiliacvesselswithvolume4.6cc, 4.5ccfortheleftandrighttesticleretrospectively;therefore,he wasofferedalaparoscopicsearch. ALaparoscopic search was preformed, both testicles were found in the level of bifurcation of common iliac artery (Figure 1), orchidopexy and TESE was done, the left testis was fixed into the externalinguinalcanaland(Figure2)founditwascontainingimmotile spermatozoa (Figure 3), while the right one was fixed into scrotum,theretrievedspecimenwasfoundtocontainsspermatids.

4. Discussion The father of cancer immunotherapy Dr. William Coley in 1911 describe a patient with bilateral UDT became a father after orchidopexThey. Dr. Coley reported this was the second described case, a century later another three cases had been reported the literature been fathers [2]. In 2020Asystematic literature review andanalysisofcasereportswasconductedonfertilitypotentialin adult men who were treated for bilateral cryptorchidism resulted thatabdominaltestesweremorelikelytobedeficientingermcells in the histological specimen with 90 % rate [3]. The incidence of cryptorchidism in full-term new-born is 2 % to 5%, therefore it consideredasthemostcommonmalecongenitalanomalies.5%of allcryptorchidismisfoundintra-abdominally,anywherealongthe linebetweenthelowerpoleofthekidneyandtheinternalinguinal ring [4] . The testicular descent from the abdomen to the scrotum happens during intrauterine life, the mechanism of this descent is poorlyunderstoodandsotheexactaetiologycausingundescended testis is not known.The testis can be located anywhere along the path of descent [5]. Most of the bilateral undescended testis develops azoospermia and most experts advocate repositioning the testis early in life to prevent future infertility as cryptorchidism for longer periods of time has profound damage to the spermatogenesis. Bilateral undescended testis carries the highest rate of infertility[3].Thelocationoftheundescendedtestisandtheageat which it was discovered is the most important prognostic factors thatdeterminefuturefertility.Theintra-abdominallocationhasthe lowest rate of spermatogenesis or retrieving viable sperms from the testis [4]. Biopsies taken from intra-abdominal testis showeda decreased count of germ cells and the rate at which these germ cells decrease increases as the patients get older. It is thought it is one of the most significant risk factors that affect future fertility. Other histological features that were found include decreased microtubule diameter and depletion of germinal cells and microliths [5]. Many Authors have studied the chance of retrieving viable sperms from the post-pubertal undescended testis and most of themcametotheconclusionitisverylowbythecurrentmethods [1, 4].

5. Conclusion Although it is extremely rare successful sperm extraction can be still achieved from bilateral intra-abdominal post-pubertal undescended testis using intra-operative TESE.

References 1. MatsushitaK,YamaguchiK,LiF,OkadaK, AndoM,ChibaK,et al. Achieved pregnancy with the delivery of a healthy child byTESEICSI 7 years after bilateral adult orchidopexy: a case report.Andrologia. 2014; 46(8): 948-50.

2. MunceyW,DuttaR,TerleckiRP,WooLL,ScarberryK.Fertilitypotentialinadultmentreatedforuncorrectedbilateralcryptorchidism:Asys tematicliteraturereviewandanalysisofcasereports.Androlo-gy. 2021; 9(3): 781-91.

3. SangsterP,Alnajjar HM,Ahmed K, Christodoulidou M,Williamson E,KellyJD,etal.MicrodissectionTESE(mTESE)followingadult orchidopexyforundescendedintra-abdominalandinguinaltesticles – surgicaltechniquesandoutcomesfromasingle-centrecohort.Andrology. 2020; 8(1): 166-70.

4. Irkilata HC, Dayanc M, Yildirim I, Cincik M,Aydur E, PekerAF.Low sperm recovery from the undescended testis with testicularsperm extraction in postpubertal cryptorchids: Preliminary report.Andrologia. 2005; 37(2): 65-8.

5. Abouzeid AA, Mousa MH, Soliman HA, Hamza AF, Hay SA. Intra-abdominaltestis:Histologicalalterationsandsignificanceofbiopsy. J Urol [Internet]. 2011; 185(1): 269-74.

Albra Hegazi. Positive TESE after Orchidopexy of Bilateral Abdominal Cryptorchidismin an Adult: A Case Report. Annals of Clinical and Medical Case Reports 2023