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Fertility and the management of scrotal injury

Fertility and the management of scrotal injury. Jackson Kirkman-Brown Science Lead & Hon Reader BWH & UoB. Background. Mid 2009 soldier, having spoken to a friend who was a GP, asked for sperm storage @2 months post injury - total orchidectomy no sperm present. 2. 2.

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Fertility and the management of scrotal injury

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  1. Fertility and the management of scrotal injury Jackson Kirkman-Brown Science Lead & Hon Reader BWH & UoB

  2. Background Mid 2009 soldier, having spoken to a friend who was a GP, asked for sperm storage @2 months post injury - total orchidectomy no sperm present 2 2

  3. Three main challenges? Improvement of patient-specific treatment including in the field evolution and validation of techniques ID and reduction of threat injury poses to fertility Increase safe and effective fertility options

  4. What currently happens in Birmingham Contact when signal arrives (18-24h before) Team prepare for case Medical review / request Procedure (generally) on 1st theatre visit The procedure Retrieval by Urologist of: vas deferens epididymal tissue

  5. Observed original patterns of blast injury to the testis A B C D F E

  6. Sperm recovery • Epididymis & vas excision started March 2010 • Tissue into media • Immediate transfer to GMP cleanroom facilities @BWH

  7. Vas storage data Cases : 34 (since March 2010) Successful retrieval : 29/34 2 deceased and sperm disposed of 1 declined storage 2 failures have alternate testicular material left 2 failures deceased note 1:50 azoospermia ‘expected’ 7 7

  8. So what does this currently mean for an individual in the future?? Treatments using intra-cytoplasmic sperm injection Future re-checks? No sperm available for storage = support and other treatment options

  9. Successes • Ongoing • Patients positive about system • Systems now established and in place • Number of those with sperm banked are currently seeking treatment • Two couples have ongoing pregnancies

  10. The future • Pelvic protection has had huge effect in reducing the number of testicular losses and the severity • Understand the short and long-term effects of blast to the testis • Blast with fragmentation / rupture • Blast without rupture • Can we further evolve protection • Ongoing androgenic and spermatogenic function

  11. Thank you This is a real interdisciplinary team effort, key colleagues: Wendy Ross, Michelle Jewell, Yongjian Chen, IngrideKrasauskaite and BWFC Team Dr Sue Avery & James Lawford-Davies John Clark, Vic Long, Steve Jeffrey, Ian Sargeant Military Burns & Plastics team; Sir Keith Porter UhB Urology Team especially Richard Viney; Steve Cumley & UhB management Davendra Sharma, David Woods, Peter Wink, Rhodri Phillip, Wendy Frappell-Cooke Wendy Williams, Richard Broadbridge, Jo Palmer

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