Cryptorchidism-pathophysiology, treatment concept and long-term follow up results

Abstract

Undescended testes (cryptorchidism), incomplete descent at birth of one or both testes affects 1-3% of boys and is the most common endocrine disease in childhood. If untreated, the undescended testis may develop progressive failure of spermatogenesis and has a higher incidence of carcinoma that may manifest in adolescence and adulthood. Endocrine and primary end organ failures are the two etiological factors most frequently held responsible for the increased incidence of infertility in unilateral and bilateral cryptorchidism. The cryptorchid testis has a typical histology showing depletion of germ cells and impaired maturation of gonocytes accompanied by intestinal fibrosis and Leydig cell atrophy. In 70% of males with isolated cryptorchidism, hypogonadotropic hypogonadism is the cause of undescended testes. The number of Ad spermatogonia that develop in infancy during the period of mini puberty (the stem cells for mature spermatozoa) is severely reduced . The ultimate aim of all therapy for cryptorchidism is to have both testes in the scrotum and to achieve normal fertility. Hormonal treatment is recommended for all patients prior to orchidopexy and those at high risk of infertility (no Ad spermatogonia). Treatment includes Kryptocur for inducing epididymo-testicular descent and Buserelin (LH-RHa) for prevention of infertility. If unsuccessful surgery should be performed before patients second birthday.