Local control of bladder-prostate rhabdomyosarcoma (BPRMS) is achieved by a combination of a conservative surgery and brachytherapy (CSBT), however, if the dose to the testis in the vicinity of the brachytherapy wires is above 2Gy it may impair the fertility. We previously described a technique of unilateral testicular transposition (TT) in 8 patients to decrease the delivered dose to the testis. We wanted to assess the surgical outcome of this technique on a larger set of patients with a longer follow-up.
We reviewed the minimal physical radiation dose to the most exposed 98% of the testis (D98), clinical (location) and ultrasound (asymmetry >30% in volume and Doppler signal) data of transposed and non-transposed testes from male patients treated for a BPRMS with a CSBT, at last follow-up, from Sept 2016 to February 2019.
Out of 26 patients: 23 had a right, 2 left, 1 bilateral TT. The D98 was 1.30 Gy [0-4.10] to the transposed compared to 5.16 Gy [1.24-12.31] to the non-transposed testis, with a significant decrease of 75% [7-100] (P<0.001) of the dose. Two patients (7.7%) experienced post-operative events (one wound infection and one scrotal exploration for pain). After 11 months [2-34] of follow-up, 15 (57%) patients had a clinical examination: 2patients (14%) had symmetric but oscillating or inguinal testis. Fourteen patients (53%) had a Doppler ultrasound: 5 (35%) had a decrease of their testis volume by 47% [36-60%], compared to the non-transposed testis. The Doppler was impaired in 2 patients and was symmetric for the others. There was no testicular atrophy or necrosis.
Unilateral TT for CSBT in BPRMS avoids a significant amount of irradiation, although a significant decrease in size and vascular impairment in 35% and 14% of patient’s transposed testes prevents us from performing a bilateral transposition.