Effects of intravesical chemotherapy and immunotherapy on semen analysis.
OBJECTIVE
To study the effect of intravesical chemo-immunotherapy on the sperm parameters of young patients.


METHODS
Twelve young male patients with superficial transitional cell carcinoma, all younger than 40 years old at surgery, were included in this prospective study. The mean patient age was 34.8 years (range 22 to 40). Of the 12 patients, 8 had superficial transitional cell carcinoma, grade 2-3, and 4 had proven invasion to the lamina propria; 1 patient had accompanying carcinoma in situ. Accordingly, adjuvant intravesical treatment with either bacille Calmette-Guérin (BCG; 6 patients) or mitomycin C (6 patients) was indicated on the basis of the initial stage and grade. Sperm analysis was performed before bladder irrigation and subsequently 3 months after completion of intravesical therapy.


RESULTS
All 12 patients had normal follicle-stimulating hormone and luteinizing hormone levels after surgery. All 12 patients had normal-volume ejaculate, except for 1 who had undergone multiple prior transurethral tumor resections. Of the 6 patients who were treated with mitomycin C, only a few minor insignificant changes in the sperm quality were noted, and 2 of them later fathered healthy children. However, in 3 of the BCG-treated patients, remarkable changes in all sperm quality parameters were evident, with a statistically significant decrease in the sperm count (P = 0.0021).


CONCLUSIONS
We suggest that potential adverse effects on spermatogenesis can be induced by intravesical therapy with BCG and that, consequently, routine pretreatment semen preservation should be considered as a precaution before instillation of intravesical BCG to prevent subsequent fertility difficulties in young men.
Raviv
Gil
G
Division of Andrology and Male Infertility, Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
Pinthus
Jehonathan H
JH
Shefi
Shai
S
Mor
Yoram
Y
Kaufman-Francis
Keren
K
Levron
Jacob
J
Weissenberg
Ruth
R
Ramon
Jacob
J
Madgar
Igal
I
D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D000283:Administration, Intravesical; D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use*; D001500:BCG Vaccine / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy*; D006801:Humans; D007167:Immunotherapy; D008297:Male; D016685:Mitomycin / Q000627:therapeutic use*; D011446:Prospective Studies; D012661:Semen / Q000187:drug effects*; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy*
D000276:Adjuvants, Immunologic; D000903:Antibiotics, Antineoplastic; D001500:BCG Vaccine; D016685:Mitomycin