ESPU Meeting on Wednesday 3, September 2025, 13:50 - 14:25
13:50 - 13:53
S02-1 (OP)
Marcel DRLÍK 1, Zuzana KRÁTKÁ 2, Tomáš FURST 3, Petra NOVÁKOVÁ 1 and Radim KOČVARA 1
1) General University Hospital and First Faculty of Medicine of Charles University, Urology, Praha 2, CZECH REPUBLIC - 2) Laboratory of Gennet, Immunology laboratory, Prague 1, CZECH REPUBLIC - 3) University of Palacky, Mathematical Analysis and Application of Mathematics, Olomouc, CZECH REPUBLIC
PURPOSE
In clinical practice, the adolescents' fertility potential is assessed using the WHO norms for adult fertile men, as there is no reference available for the adolescents. The aim of study was to determine ejaculate quality in healthy adolescents and compare with adult norms.
MATERIAL AND METHODS
We prospectively recruited 44 healthy boys without any genital or syndromic pathology, aged 15-17 years at Tanner 5 puberty stage and analysed 2 semen samples collected 4 weeks apart. We examined a standard spermiogram and 3 functional parameters (% of non-apoptotic spermatozoa, acrosome permeability and fragmented DNA) by flow cytometry. Only pathological findings in both samples were considered abnormal. We determined the frequency of abnormal findings for each parameter, established a reference range of 25th-75th percentiles and compared the results with WHO norms.
RESULTS
At least one repeatedly found abnormal parameter on spermiogram had 16 (36.3 %), on flow cytometry 35 (79 %) boys. The most common abnormal parameter was progressive motility in 10 (22.7 %), % of non-apoptotic spermatozoa in 15 (34 %) and % of acrosome permeability in 24 (55 %) boys. Reference ranges are summarized in the Table.
| Parameter | 25-75th percentil | Reference value for adults |
| Volume (ml) | 1.5-3.0 | >1.5 |
| Sperm count (10E6) | 68.6-156.2 | >39 |
| Sperm concentration (10E6) | 30.1-68.8 | >16 |
| Progresive motility(%) | 27.4-54.3 | >30 |
| Abnormal morphology(%) | 90.7-95.4 | <96 |
| Non-apoptotic sperm(%) | 38.7-58.3 | >50 |
| Permeable acrosome(%) | 29.4-44.4 | <30 |
| DNA fragmentation(%) | 5.2-10.6 | <20 |
CONCLUSIONS
We set reference values for spermiogram and functional semen parameters for adolescents. One third of examined healthy adolescents´ samples did not meet adult spermiogram standards. The most frequent was low progressive motility. Three quarters of adolescents´samples failed to meet the standards for functional parameters (proportion of apoptotic sperm and/or sperm with permeable acrosome). All boys met the standard adult criteria for % DNA fragmentation.
13:53 - 13:56
S02-2 (OP)
Kaylee BRESSLER 1, Israel FRANCO 2, Alex FANG 1, Diego ALVAREZ 1, Jordan MENDELSON 1, Ronnie FINE 1, Mark HOROWITZ 1, Steven FRIEDMAN 1 and Jordan GITLIN 1
1) NYU Langone, Pediatric Urology, Westbury, USA - 2) Yale School of Medicine, Clinical Urology, New Haven, USA
PURPOSE
Future fertility has long been a concern associated with varicoceles. Changes in testicular blood flow in patients with varicoceles has been well documented. This study aims to correlate flow changes with semen parameters and hypothesizes that increased arterial flow will be correlated with better semen parameters, resulting in increased fertility.
MATERIAL AND METHODS
A retrospective single institution chart review was conducted of adolescent patients who were Tanner stage V with a palpable, left sided varicocele that had not been operated on, and who had undergone at least one semen analysis and ultrasonography test. Doppler ultrasound findings and semen analysis values were recorded. Descriptive statistics, univariate logistic regression, and ROC analysis were done using SPSS.
RESULTS
A total of 149 patients were included with a mean age of 18.2 (± 1.4) years old. The average peak systolic velocity was 11.33 (± 4.70) cm/s and average end diastolic velocity was 5.3 (±5.1). Univariate analysis of flow data revealed peak systolic velocity was significantly associated with total motile sperm count (TMSC), with an odds ratio of 1.37 (95% CI: 1.08-1.73, p=0.010) indicating that a one unit increase in velocity was associated with a 137% increase in TMSC. The cutoff was found to be 10.2 cm/second with a specificity of 93% and sensitivity of 56%.
CONCLUSIONS
Higher flow rates in the testicular artery were shown to be associated with a higher TMSC. In the future, use of ultrasound evaluation of flow parameters in patients with varicoceles may help with clinical decision making and when you should intervene.
14:04 - 14:07
S02-3 (OP)
Sabine ZUNDEL 1 and Philipp SZAVAY 2
1) Children's Hospital of Central Switzerland, Paediatric Surgery, Luzern, SWITZERLAND - 2) Children's Hospital of Central Switzerland, Peadiatric Surgery, Lucerne, SWITZERLAND
PURPOSE
Sparing lymphatic vessels during Palomo varicocelectomy significantly reduces the rate of postoperative hydrocele. Intratesticular lesions are reported to occur in 4.1 to 19% of cases following intratesticular injection of dyes. We describe the first case series of paratesticular injection of indocyanine green (ICG) for lymphatic-sparing Palomo procedure on 17 consecutive patients.
MATERIAL AND METHODS
In July 2021, we transitioned from using patent blue to ICG in our standard lymphatic-sparing technique. All patients scheduled for ICG-lymph sparing Palomo Procedure were enrolled in this prospective study. Surgical treatment was recommended if testicular size difference exceeded 20% or patients reported long-term complaints after detailed counselling about the pathology. After laparoscopy was installed, 2ml of ICG was injected paratesticularly at three different locations.
RESULTS
Visualization was successful in 16 of the 17 patients within seconds of the injection, and lymphatic sparing was achieved in all these cases. The 17th patient had a history of perforated appendicitis with extensive intraperitoneal adhesions and scarring. While ICG injection facilitated the identification of the testicular vessels, selectivity was lost by the time the vessels were dissected. A non-lymphatic-sparing Palomo procedure was performed.
Regression of the varicocele was observed in all cases, and no patient developed a hydrocele. All testes grew postoperatively with ten demonstrating catch-up growth three months postoperatively.
CONCLUSIONS
Our preliminary data suggest that paratesticular injection of ICG enables reliable visualization of lymph vessels. Considering the reported incidence of intratesticular lesions following intratesticular injection, we believe that paratesticular injection should be the treatment of choice.
14:07 - 14:10
S02-4 (OP)
Meghan DAVIS, Jason VAN BATAVIA, Sameer MITTAL, Karl GODLEWSKI, Arun SRINIVASAN, Aseem SHUKLA, Katherine FISCHER and Thomas KOLON
Children's Hospital of Philadelphia, Urology, Philadelphia, USA
PURPOSE
Testicular volume differential (TVdiff) has been one driver of treatment for adolescent varicocele. We incorporate additional parameters of semen analysis (SA) and serum hormone labs which are predictive of risk for infertility. We hypothesized that placing less emphasis on TVdiff and more on SA and hormone analysis would decrease healthcare utilization, interventions, and cost.
MATERIAL AND METHODS
Adolescent males with a varicocele followed at a high-volume center were evaluated by scrotal ultrasound (SCRUS), SA, FSH, and inhibin B. Patients with history of cryptorchidism or orchiectomy were excluded. Clinical data were examined utilizing an algorithm incorporating only TVdiff (Algorithm 1) compared to SA and hormone labs (Algorithm 2).
RESULTS
178 patients were identified. Mean age at diagnosis was 14.6 years. Mean age at first SCRUS, hormone studies, and SA were 16.5, 17.2, and 17.4 years respectively. Based on a TVdiff > 0.2 on SCRUS (Algorithm 1), 23 patients would have undergone varicocelectomy. However, based on Algorithm 2 that incorporated SA and hormone studies, five were recommended for varicocelectomy (one lost to follow-up prior to scheduling), five were discharged after further reassuring evaluation with SA and hormones, and the remaining 13 have ongoing work-up or were lost to follow-up. Overall, 21 patients actually underwent varicocelectomy, 17 had a normal TVdiff but abnormal SA and labs prompted surgery. Of the patients who underwent varicocelectomy, 66% had a post-operative SA; of which 71% were improved from pre-operative SA.
CONCLUSIONS
Management that employs SA and hormone labs can identify males who would benefit from varicocelectomy beyond those identified with TVdiff alone. At the same time, a management algorithm focused on TVdiff alone may result in unnecessary surgical intervention, while missing an opportunity to intervene on males at risk for infertility by labs and SA.
14:10 - 14:13
S02-5 (OP)
Michael HSIEH 1, Amanda ZIELEN 2, Karen PETERS 3, Gunapala SHETTY 4, Deborah GROSS 2, Carol HANNA 5, Serena DOVEY 3, Anna WECHT 6, Glenn CANNON 7, Marvin MEISTRICH 4, Kathleen HWANG 6 and Kyle ORWIG 2
1) Children's National Hospital, Urology, Washington, USA - 2) Magee Women's Hospital, UPMC Magee Center for Reproduction and Transplantation, Pittsburgh, USA - 3) Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Science, Pittsburgh, USA - 4) The University of Texas MD Anderson Cancer Center, Department of Experimental Radiation Oncology, Houston, USA - 5) Oregon National Primate Research Center, Assisted Reproductive Technology Core, Beaverton, USA - 6) UPMC Magee-Womens Hospital, Department of Urology, Pittsburgh, USA - 7) UPMC Children's Hospital of Pittsburgh, Urology, Pittsburgh, USA
INTRODUCTION
With improved therapies, childhood cancer patients can live full lives after cure, including the possibility of having children. Unfortunately, some cancer treatments cause infertility. The only option to preserve fertility in prepubertal boys who are not producing sperm is to cryopreserve their immature testicular tissue or cells, including spermatogonial stem cells (SSCs). Herein we describe ten years of Children's National Hospital (CNH) experience in testicular tissue cryopreservation for SSC transplantation as part of a large multicenter study based at the University of Pittsburgh.
PATIENTS
Inclusion criteria included boy undergoing treatment with significant risk of inducing infertility and/or a condition requiring partial or radical orchiectomy. Exclusion criteria included patients with high risk of anesthetic or surgical complications and psychiatric conditions preventing giving fully informed assent/consent.
RESULTS
From April 2015 through January 2025, 207 patients were approached for study participation and 139 were enrolled. This 10-year effort has culminated in the first application of ultrasound-guided rete testis injection (in 2023) to transplant SSCs into the testis of an adult survivor of childhood cancer treated at CNH. During this presentation we will discuss the preclinical work leading up to this transplantation, as well as semen analysis outcomes.
CONCLUSIONS
Our decade-long effort demonstrates the feasibility of TTC and SSC transplantation in adult survivors of childhood cancer. Dissemination and refinement of associated techniques will result in fertility restoration in this emerging patient population.