PD25-12 FERTILITY POTENTIAL OF MEN TREATED FOR UNCORRECTED BILATERAL CRYPTORCHIDISM AS ADULTS: A SYSTEMATIC LITERATURE REVIEW

Abstract

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation II (PD25)1 Apr 2020PD25-12 FERTILITY POTENTIAL OF MEN TREATED FOR UNCORRECTED BILATERAL CRYPTORCHIDISM AS ADULTS: A SYSTEMATIC LITERATURE REVIEW Wade Muncey*, Rahul Dutta, Ryan P. Terlecki, Lynn L. Woo, and Kyle Scarberry Wade Muncey*Wade Muncey* More articles by this author , Rahul DuttaRahul Dutta More articles by this author , Ryan P. TerleckiRyan P. Terlecki More articles by this author , Lynn L. WooLynn L. Woo More articles by this author , and Kyle ScarberryKyle Scarberry More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000882.012AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bilateral undescended testicles (bUDT) is typically recognized early in life, but may go unaddressed into adulthood. Guidelines on post-pubertal management are lacking, and the hormonal and fertility benefits of adult orchidopexy (OP) are not well established. We aim to conduct a literature review to determine an evidence-based approach to management. METHODS: A systematic literature review, conforming to the PRISMA statement, was conducted using the PubMed/Medline databases through October 2019 using the search terms “adult cryptorchidism” and “adult orchidopexy.” Any report or series including an adult (age>17) with untreated, bilateral undescended testicles was included. RESULTS: 51 reports were identified with 209 adults with uncorrected bUDT included for analysis. Semen analysis (SA) identified azoospermia in 100% (139/139). Unilateral (23%) or bilateral (77%) OP was performed in 132 men. Intraabdominal testicles were identified in 40 patients (30%), one or both inguinal testicles in 38 (29%), or unspecified location in 54 (41%). SA after OP was reported in 43 men (age 18-38) in 14 series with 11 cases (25.6%) identifying return of sperm to ejaculate. Five reports described delayed testicular sperm extraction (TESE) in 18 men with persistent azoospermia at a median of 8 (6-168) months after OP with success in 8 (44%). Only 1 report exists of sperm obtained after OP for intraabdominal testicles. The remainder had OP for inguinal testicles (13) or unspecified location (5). Successful paternity was reported in six men: natural conception (2), intrauterine insemination (1), intracytoplasmic sperm injection (ICSI) with ejaculated sperm (1), and TESE + ICSI (2). TESE was performed in 12 men at time of OP with 0% sperm retrieval. One man had successful TESE 84 months after failed TESE during OP. Pathology of 55 UDTs in 40 men following pre-OP biopsy (64%) or contralateral orchiectomy (36%) revealed no cases (0%) of mature spermatozoa identification and complete lack of germ cells in 51%. Median testosterone in 67 men was 360 ng/dl (90-700), with hypogonadism identified in 9 (13%), but normal puberty reported in all. One report noted de novo hypogonadism post-OP. CONCLUSIONS: Azoospermia is the rule in adults with uncorrected bUDT, but testosterone is sufficient for pubertal development. Adult orchidopexy can restore spermatogenesis, with retrieval noted from ejaculate or TESE. TESE of the uncorrected UDT is of limited benefit and should be abandoned and reserved for after OP. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e543-e543 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wade Muncey* More articles by this author Rahul Dutta More articles by this author Ryan P. Terlecki More articles by this author Lynn L. Woo More articles by this author Kyle Scarberry More articles by this author Expand All Advertisement PDF downloadLoading ...