Neoadjuvant human Chorionic Gonadotropin (hCG) therapy may improve the position of undescended testis: a preliminary report.

Abstract

IntroductionTreatment of cryptorchidism includes hormonal therapy and/or operative methods. To evaluate effectiveness of neoadjuvant hCG-therapy in cryptorchid boys regarding testicle position before and after treatment.Material and methods204 boys with 229 UDT, median age at presentation 6,6 years, SD ±3.4; 179 (87.7%) with unilateral and 25 (12.3%) with bilateral defect were treated between 1994 and 2008. 103 boys (119 gonads – 51.9%) underwent orchiopexy alone, while 101 boys (110 gonads – 48.1%) neoadjuvant hCG-therapy. The testicle position was evaluated before and one year after therapy. Every patient was seen in our outpatient department 2 to 16 years after the therapy.ResultsOut of 110 testes of 101 boys after hCG-therapy, 49 testicles (44.5%) descended to the scrotum and these 44 patients were not qualified for orchiopexy. Remaining 61 testes (55.5%) did not reach the scrotum after hormonal therapy and these 57 boys underwent orchiopexy. Gonadotropin induced the descent of 90 out of 110 testicles at least one level down, therefore overall effectiveness of hCG therapy was 81.8% (chi = 29.778, p = 0.000). 49 out of 110 UDT descended to the scrotum (44.5%). The efficacy of hormonal treatment did not depended on initial position of UDT (p = 0.43, p = 0.04, p = 0.97). We performed only 7 orchidectomies of disgenetic testes (3.1%). Neither type of treatment nor initial position of testicle influenced the future gonad atrophy (p = 0.5, p = 0.979).ConclusionsNeoadjuvant hCG-therapy induced descent to the scrotum of 44.5% UDT and improved position of testis before orchidopexy in further 37.3% of patients.