Cryptorchidism And Male Fertility Potential: Histological Features And Correlation To Timing Of Orchiopexy And Location Of Testes

Abstract

PURPOSE Cryptorchidism affects ∼ 3% of term newborn and adversely affects future fertility. This study was designed to identify clinical features that correlate with pathologic changes in children with cryptorchidism with the ultimate goal of determining the optimal time to perform orchiopexy. MATERIAL AND METHODS A retrospective review of all patients (n = 241) who underwent orchiopexy and concurrent testicular biopsy between 1991 and 2001 was conducted. For this cohort, multipredictor logistic regression was used to determine if age at orchiopexy, testis location prior to surgery, unilateral vs. bilateral disease, were predictors of three different pathologic outcomes (germ cell depletion, Leydig cell depletion, and presence or absence of significant fibrosis). RESULTS Germ cell depletion was associated with increased age at orchiopexy and intraabdominal/non-palpable testes. When adjusted for testis location, the odds ratio (OR) for significant germ cell depletion was 1.02 (p < 0.005) for each month increase in age. After adjusting for age, children with palpable testis had much lower odds of germ cell depletion than those with non-palpable testis (OR 0.46; p < 0.002). For Leydig cell absence, the OR was 1.01 (p < 0.005) for each month increase in age. These results correspond to a significant 1-2% increase in the development of germ cell depletion or Leydig cell absence for each month of age in a child with cryptorchidism and a 50% increased risk of germ cell depletion in intraabdominal testes relative to palpable testes. CONCLUSIONS Non-palpable testes and testes that remain undescended for an increased duration are associated with histologic changes that could be the cause for decreased fertility in adulthood. By operating on these testes early, especially the non-palpable ones, it is conceivable that the number of germ cells and Leydig cells in the adult testis might be improved, and the risk of infertility reduced. Cryptorchidism affects ∼ 3% of term newborn and adversely affects future fertility. This study was designed to identify clinical features that correlate with pathologic changes in children with cryptorchidism with the ultimate goal of determining the optimal time to perform orchiopexy. A retrospective review of all patients (n = 241) who underwent orchiopexy and concurrent testicular biopsy between 1991 and 2001 was conducted. For this cohort, multipredictor logistic regression was used to determine if age at orchiopexy, testis location prior to surgery, unilateral vs. bilateral disease, were predictors of three different pathologic outcomes (germ cell depletion, Leydig cell depletion, and presence or absence of significant fibrosis). Germ cell depletion was associated with increased age at orchiopexy and intraabdominal/non-palpable testes. When adjusted for testis location, the odds ratio (OR) for significant germ cell depletion was 1.02 (p < 0.005) for each month increase in age. After adjusting for age, children with palpable testis had much lower odds of germ cell depletion than those with non-palpable testis (OR 0.46; p < 0.002). For Leydig cell absence, the OR was 1.01 (p < 0.005) for each month increase in age. These results correspond to a significant 1-2% increase in the development of germ cell depletion or Leydig cell absence for each month of age in a child with cryptorchidism and a 50% increased risk of germ cell depletion in intraabdominal testes relative to palpable testes. Non-palpable testes and testes that remain undescended for an increased duration are associated with histologic changes that could be the cause for decreased fertility in adulthood. By operating on these testes early, especially the non-palpable ones, it is conceivable that the number of germ cells and Leydig cells in the adult testis might be improved, and the risk of infertility reduced.