n EFFECTS OF SURGERY ON MALE REPRODUCTION Removal of a testicle may cause infertility (lack of sperm) and hypogonadism (decreased testosterone), especially if the pelvis or testes region are exposed to radiation. Males who have both testes removed will be infertile. Boys who have pelvic surgery, which includes cystectomy (bladder surgery), may experience sexual prob- lems due to the location of the testes near surgery site. Surgery near or on the spine may also cause sexual problems in males. Boys who have large solid tumors near the prostate, lower back, and testes may need surgery, which can damage the nerves that control penile function and may cause problems starting or maintaining an erection or with the quality of ejaculation. The quality of the ejaculation includes the number of sperm present, the health of the sperm, and the motility of the sperm.
n OPTIONS FOR SAVING FERTILITY AT THE TIME OF TREATMENT There are many options for saving fertility in
children diagnosed with cancer, but the use of each option depends on your child’s age, the severity of disease at the time of diagnosis, additional medical concerns, and cost. Insurance may not cover any expenses for treatments to save fertility. The barriers to fertility preservation include the need to begin cancer treatment immediately, the cost, obtaining consent during a stressful time, as well as ethical and cultural issues.
Some options for fertility preservation, such as sperm banking, have been performed for decades and are not experimental. There may be research or experimental options available to your child. Experimental means that the safety of the treatment is not known either because no pregnancies in humans have occurred or there have not been enough pregnancies to understand the long-term outcomes of the fertility preservation technique. NON-EXPERIMENTAL OPTIONS FOR SAVING FERTILITY IN MALE PATIENTS BEFORE AND AFTER PUBERTY • Shielding of the testes during radiation therapy: a special material (lead) vest is put over the child’s testes. This can be done during radiation therapy that does not need to include the testes. • Moving the testes: one or both testes are surgically moved outside the radiation treatment location, to another area of the body. This must be done prior to radia- tion therapy. If the testes require radiation therapy this is not an option.
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