Microsurgical Onco‐Testicular Sperm Extraction in a Patient With Testicular Cancer and Congenital Unilateral Testicular Absence: A Case Report

ABSTRACT Introduction Testicular cancer primarily affects men of reproductive age. Therefore, fertility preservation is important in managing testicular cancer. In patients with a solitary testis, oncological testicular sperm extraction (onco‐TESE) is used to retrieve sperm from tumor‐bearing testis. Case Presentation A 39‐year‐old man with congenital absence of the left testis presented with a 4‐month history of progressive right testicular swelling. Laboratory tests showed elevated β‐human chorionic gonadotropin and follicle‐stimulating hormone concentrations, and ultrasonography showed a heterogeneous hypoechoic mass with microcalcifications. A seminal analysis showed azoospermia with AZFc partial deletion. Following orchiectomy, microsurgical onco‐TESE was performed. Motile sperm were successfully retrieved from preserved seminiferous tubules. A pathological examination demonstrated a pure seminoma. In preserved seminiferous tubules, the Johnsen score was 9–10, and partial tubular hyalinization and microcalcifications were observed. Conclusion Microsurgical onco‐TESE is for retrieving sperm in patients with testicular cancer with a solitary testis, even in the presence of impaired spermatogenesis.