Successful Orchiopexy Research Articles

Етапна лапароскопічна тракційна орхіопексія за Shehata: перший досвід, технічні особливості, результати

Purpose – to evaluate the results of proposed method of staged laparoscopic traction orchiopexy by Shehata on the basis of our own experience in the treatment of children with abdominal cryptorchidism. Materials and methods. During the period 2019–2021, 18 boys aged 9 months – 4 years were operated with staged laparoscopic traction orchiopexy procedure. Right unilateral abdominal cryptorchidism observed in 10 children, left – in 6, bilateral – in 2. Indications for the procedure were cases of intra-abdominal testicular retention with short vessels. Results. Pelvic and iliac retentions observed in 44% of cases. In 22% testicles were located close to the inner inguinal ring, in 33% the distance between testicle and inguinal canal opening reached 3–4 cm. The 2nd stage was carried out in 3 months. Successful orchiopexy was conducted then in 94% cases without any vascular tension. No cases of testicular dislocation or atrophy have been reported. The volume of operated testicles was smaller than the healthy ones in 78% cases objectively. Conclusions. The experience of Shehata operation showed good effect of the method for correction of abdominal cryptorchidism. Indications for staged laparoscopic traction orchiopexy are abdominal undescended testicles with insufficient length of vessels. The technique allows to achieve effective elongation of spermatic vessels in a short period of time and to minimize the risks of atrophy, compared with the 2-stage Fowler–Stephens operation. This study was conducted in accordance with the principles of the Helsinki Declaration. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed parental agreement was obtained for the research. No conflict of interests was declared by the authors. Key words: abdominal cryptorchidism, orchiopexy, staged treatment, Shehata procedure.

Fertility Potential is Compromised in 20% to 25% of Boys with Nonsyndromic Cryptorchidism despite Orchiopexy within the First Year of Life

One of the concerns surrounding cryptorchidism is the risk of impaired fertility. Current guidelines recommend orchiopexy at age 6 to 12 months to optimize fertility outcome. We evaluated the fertility potential of boys with nonsyndromic cryptorchidism who underwent orchiopexy within the recommended age range to clarify the need for eventual supplemental treatment modalities. We retrospectively evaluated mini-puberty hormones (follicle-stimulating hormone, luteinizing hormone and inhibin B) and testicular biopsies from boys with cryptorchidism who underwent orchiopexy within the first year of life between 2010 and 2019. We histologically analyzed germ cell number and type A dark spermatogonia number per seminiferous tubule cross-section in relation to normal values. Of the 333 boys with nonsyndromic cryptorchidism 83 (25%, 21% with bilateral cryptorchidism) had a reduced number of germ cells. A total of 70 boys (21%) had low serum inhibin B, of whom 32 (46%) had a decreased number of germ cells and 23 (33%) had a decreased number of type A dark spermatogonia (p <0.01). Overall, 75 boys (23%) had no type A dark spermatogonia present. Despite early and successful orchiopexy, 20% to 25% of boys with cryptorchidism may be at risk for infertility based on hormonal and histological data. Blood test and testicular biopsy are mandatory to identify boys at high risk for infertility, in whom additional treatment modalities and followup may be needed.

Laparoscopic one-stage orchiopexy for transverse testicular ectopia

Abstract In most patients with a non-palpable undescended testis, the location of each testis is near each inguinal canal, irrespective of whether the testis is in the abdominal cavity or in the inguinal canal. Preoperative diagnostic ultrasonography can be used to determine the status and location of the testis, and orchiopexy is recommended before 18 months of age. In recent years, laparoscopic operations have been frequently performed, and treatment has been simultaneously provided with diagnosis. Here I report successful laparoscopic one-stage testicular vessel-preserving orchiopexy in two cryptorchidism patients with both testes on one side of the inguinal canal. Laparoscopic orchiopexy is technically applicable and safe, without prolongation of the operation time or an increase in postoperative complications. Laparoscopic one-stage testicular vessel-preserving orchiopexy is an effective treatment approach for a non-palpable undescended testis located in the unilateral inguinal canal.

Splenogonadal fusion in an 18-month-old

Splenogonadal fusion is rare abnormal congenital connection of splenic tissue and gonad. It commonly presents with either cryptorchidism or as a palpable mass. As a benign anomaly, orchiectomy is often unnecessary. Removal of the splenic component may be accomplished with preservation of the testicle. An 18-month-old boy presented with right cryptorchidism and left retractile testicle. Laparoscopic examination found a viable right testicle, and a successful orchiopexy was performed. The left testicle demonstrated splenogonadal fusion. Discontinuous accessory splenules were noted along the path of testicular descent. After confirmation from a radionucleotide liver-spleen scan the patient was brought back to the operating room for open excision of the adherent splenic tissue and orchiopexy of the testicle via an open inguinal approach. Splenogonadal fusion is a rare condition, but may be suspected in children with cryptorchidism or palpable peri-testicular mass. As with the present patient, in most cases the splenic tissue may be successfully excised without injury to the testicle.

Two Cases of Successful Laparoscopic Hernia Repair and Repositioning of the Testes into the Abdominal Cavity in Pediatric Patients with Androgen Insensitivity Syndrome

Some infants with androgen insensitivity syndrome (AIS) reportedly develop inguinal hernia (IH). These infants’ testes are mostly located in the proximal deep inguinal ring or abdominal cavity. There are few reports on testes present in the labia majora (distal to the superficial inguinal ring) in newborns; however, there is no report on testes fixed to the labia majora that were preserved and moved into the abdominal cavity. Here two cases of successful laparoscopic hernia repair and orchiopexy to move the testes from the labia majora into the abdominal cavity in pediatric patients with AIS having IH are reported.

For Better Orchiopexy, Processus Vaginalis Should Be Dissected and a High Ligation Should Be Performed.

ObjectiveData on the prevalence of patent processus vaginalis (PPV) and hernia in patients with cryptorchidism are controversial. While some pediatric surgeons do not dissect the processus vaginalis (PV), most prefer to do so to prevent hernia formation and to achieve an effective orchiopexy outcome. This study was performed to evaluate the importance of dissection and high ligation of the PV during treatment of undescended testis (UT).MethodsThe clinical findings and surgical procedures of 55 patients with UT were retrospectively investigated.ResultsThe mean patient age was 2.5 (range 1.0–12.0) years. Non-palpable testis (NPT) was located on the right and left side in 39 and 16 patients, respectively. Ultrasonography revealed no testis in 10 patients and an atrophic testis in 7 patients. Seven patients had a parent with an inguinal hernia, and the silk sign or a PPV was detected during inguinoscrotal examination in 22 patients. Undescended testis repair was performed by an inguinal approach in all patients. The inguinal canal was opened in all patients; 42 patients had a wider-than-normal internal ring (>2.5 cm), and the posterior wall of the inguinal canal was consequently weakened. Two-stage orchiopexy was performed in 2 patients, and 15 underwent the Prentiss maneuver. In the remaining patients, the dissection was easily done, and the orchiopexy was performed without any difficulty. Scrotal edema and wound infection occurred in five and two patients, respectively. One patient presented with an atrophic testis, and three had recurrent UT. Inguinal hernia was not observed in any of the patients during the study period, and all procedures were performed on an outpatient basis.ConclusionHigh ligation of the PV is an effective method for successful orchiopexy and prevention of inguinal hernia in patients with NPT and UT.

Orchiopexy without Transparenchymal Fixation Suturing: A 29-Year Experience

We sought to gain insight into the outcomes of nontunical orchiopexy through assessment of elective and emergent orchiopexies performed by a single surgeon from 1985 to 2014. We demonstrate that successful orchiopexy does not require a fixation suture that pierces the tunica albuginea. We retrospectively analyzed 1,104 orchiopexies in patients 1 day to 25 years old performed by a single urologist during a 29-year period. A total of 155 procedures were performed in 101 patients to remedy torsion, and 949 procedures were performed in 778 patients for undescended testes. The orchiopexy method for all patients was the same, involving no transparenchymal fixation suture. Operative notes, followup appointments and long-term testicular condition were analyzed. Appropriate testicular size and position were considered successful outcomes. Testicular atrophy, suprascrotal location, torsion and long-term pain were considered undesired outcomes. Of the 1,104 orchiopexy cases evaluated 1,090 were deemed successful, with normal testicular position and size postoperatively. A total of 14 testes in 8patients showed undesired outcomes (postoperative atrophy in 4 testes, long-term pain in 2 and failure to retain appropriate position postoperatively in 8). Orchiopexy avoiding transparenchymal suturing through the tunica albuginea is a successful approach for fixation of the testis in the scrotum. Considering the high rate of favorable outcomes with this technique, and assuming that tunical invasion negatively impacts spermatogenesis, we consider a tunical suture unnecessary.

1529 OPENING THE INGUINAL CANAL IS UNNECESSARY IN INGUINAL ORCHIOPEXY

You have accessJournal of UrologyPediatrics: Congenital Anomalies - Lower Urinary Tract & Genitalia I1 Apr 20121529 OPENING THE INGUINAL CANAL IS UNNECESSARY IN INGUINAL ORCHIOPEXY Frank J. Penna, Jack S. Elder, and Mireya Diaz Frank J. PennaFrank J. Penna Detroit, MI More articles by this author , Jack S. ElderJack S. Elder Detroit, MI More articles by this author , and Mireya DiazMireya Diaz Detroit, MI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1297AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In boys with an inguinal testis, the traditional approach is to perform an inguinal incision, open the inguinal canal, mobilize the testis and spermatic cord, repair the inguinal hernia if present, and place the testis in a dartos pouch in the scrotum. In boys, the inguinal canal is short and during inguinal hernia repair, it is often unnecessary to extend the dissection to the internal inguinal ring in order to mobilize enough length. The purpose of this study is to determine if performing a modified inguinal orchiopexy (without opening the inguinal canal) results in a successful orchiopexy. METHODS Boys with an inguinal testis who underwent orchiopexy were reviewed retrospectively. Patient age and surgical approach (inguinal, with or without inguinal dissection, or prescrotal) were recorded. Only if the testis did not reach the dartos pouch was the inguinal canal opened and a standard orchiopexy performed with inguinal dissection. Presence of an inguinal hernia was also noted. All patients underwent clinical follow-up at 4-6 weeks. Boys with an ectopic, abdominal or absent testis and those undergoing previous inguinal surgery were excluded. RESULTS A total of 254 boys with 323 undescended inguinal testes were reviewed. The results are shown in Table 1. Overall, 171 underwent a modified inguinal orchiopexy without opening the inguinal canal, 36 underwent inguinal orchiopexy with standard inguinal dissection, and 116 underwent prescrotal orchiopexy. A total of 123 (38.1%) testes were associated with an inguinal hernia that was repaired during orchiopexy. Of those with a hernia, 92 underwent a modified inguinal orchiopexy, 23 underwent a standard inguinal orchiopexy, and 9 were corrected via a prescrotal approach. There was one complication of testicular re-ascent in the modified inguinal orchiopexy group. Inguinal (M) Inguinal (S) Prescrotal Total No. testis 171 36 116 323 Mean age (yrs.) 5.1 5.9 4.9 5.1 Hernia 92(54%) 23(64%) 9(8%) 123(38%) No. side Lt 79 20 56 155 Rt 92 16 60 168 No. complications 1(0.5%) 0(0%) 0(0%) 1(0.3%) (M) = modified, (S) = standard CONCLUSIONS In boys with an inguinal undescended testis, orchiopexy can be performed without opening the inguinal canal, even if there is an associated inguinal hernia, with the decision being dependent upon the ability to mobilize the testis and spermatic cord into the dartos pouch. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e619 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Frank J. Penna Detroit, MI More articles by this author Jack S. Elder Detroit, MI More articles by this author Mireya Diaz Detroit, MI More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Initial Pre-Scrotal Approach for Palpable Cryptorchid Testis: Results During a 3-Year Period

Pre-scrotal orchiopexy is emerging as an alternative approach for cryptorchid testes that can be preoperatively mobilized into the scrotum. We present our 3-year pre-scrotal orchiopexy series for all palpable cryptorchid testes regardless of their mobility into the scrotum preoperatively. We retrospectively reviewed all patients who underwent pre-scrotal orchiopexy during a 3-year period. Data collected included preoperative and postoperative testicular position, mobility of the testis into the scrotum preoperatively or with the patient under general anesthesia, patency of processus vaginalis, operative times and complications. A total of 88 cryptorchid testes were treated using single pre-scrotal incision orchiopexy. Mean patient age was 4.9 years. Of the testes 74 (84.1%) could be milked down to the scrotum preoperatively and 14 (15.9%) could not. Of the 14 immobile testes 8 were intracanalicular and 6 were in the superficial inguinal pouch. Pre-scrotal orchiopexy was successful in all 74 testes that were mobilized into the scrotum preoperatively. However, 6 of 14 testes (43%) that could not be moved to the scrotum were effectively managed by a single pre-scrotal incision, while 8 (57%) required an additional groin incision for successful orchiopexy. No complications were observed during a mean followup of 7.1 months. Orchiopexy using a pre-scrotal approach is a viable alternative for palpable cryptorchid testes that can be preoperatively mobilized into the scrotum. Cryptorchid testes that are palpable but cannot be moved to the scrotum can be managed by the pre-scrotal approach alone in 40% of cases or with an additional groin incision in 60%.

An Evolution of Orchiopexy: Historical Aspect

The history of treatment for cryptorchidism dates back more than 200 years. This review is intended to highlight some historical aspect that led us to our current surgical treatment of this condition. The medical and historical surgical literatures pertaining to cryptorchidism were reviewed. Data sources were PubMed, Embase, conference proceedings, and bibliographies. No language, date, or publication status restrictions were imposed. The study of cryptorchidism began with the anatomical descriptions of Baron Albrecht von Haller and John Hunter. Attempts at surgical correction of the undescended testis began in the early 1800s, culminating in the first successful orchiopexy by Thomas Annandale in 1877. Max Schüller, Arthur Dean Bevan and Lattimer contributed to the establishment of current techniques for standard orchiopexy. Later, laparoscopy, high inguinal incision (Jones' approach) and scrotal approach were added to the list of current orchiopexy.

Successful treatment of unilateral cryptorchid boys risking infertility with LH-RH analogue

Infertility is the primary concern for boys with uni- or bilateral undescended testes. An early and seemingly successful orchiopexy does not improve fertility in a substantial number of cryptorchid males. We confirmed that LH-RH analogue (LH-RHa) treatment induces an increase in and maturation of the germ cells; however, it was uncertain if treatment would improve the chance of fertility later in life. Thirty unilateral cryptorchid boys, with an average age of 3 years at the time of surgery, were included in the study. Testicular biopsy showed that they had impaired testicular maturation and were therefore at high risk for infertility. Fifteen of the 30 unilateral cryptorchid boys were treated with 10 microg LH-RHa (Buserelin) nasal spray, administered on alternate days for a period of 6 months, following orchiopexy. The control group consisted of 15 cryptorchid boys who had been treated by Schoemakers type of orchiopexy, alone. After puberty, the ejaculates of both groups were analyzed. All males in the untreated group were severely oligospermic, with 20% being azoospermic. In contrast, 86% of the treated ex-cryptorchid males had a sperm concentration within the normal range; this was significantly different from the sperm concentration found in the untreated group (p=0.000008). For the first time, we demonstrate that infertility in cryptorchidism can be successfully corrected when suitably treated with a LH-RHa. Sperm parameters normalized following therapy in the majority of cryptorchid males who, untreated, would have remained infertile. This innovative hormonal treatment will have a profound effect on the current recommended surgical treatment of boys with undescended testes.

TESTICULAR MICROLITHIASIS AND ANTISPERM ANTIBODIES FOLLOWING TESTICULAR BIOPSY IN BOYS WITH CRYPTORCHIDISM

Testicular biopsy (TBx) performed during orchiopexy in boys with cryptorchidism can help to predict future semen analyses and possibly identify patients at risk for testicular cancer. It has been theorized that TBx can be detrimental to the long-term health of the testis. We examined testicular microlithiasis (TM) and antisperm antibody (ASA) production in cryptorchid TBx. A total of 112 males underwent fertility evaluation. These patients had previously undergone orchiopexy and bilateral TBx (mean age 8.6 years) for unilateral or bilateral undescended testis. At a mean age of 19.6 years all patients underwent physical examination and scrotal ultrasound for evaluation of testis size, echotexture and abnormalities. Of 112 patients 57 also underwent direct Immunobead(R) assay with positive controls. Moving sperm free and/or bound to IgG bead complex were counted in the preparation. A total of 29 patients had bilateral and 83 had unilateral undescended testis. Of the 112 patients 26 were black and 86 were white. Four black patients (15.4%) and 4 white patients (4.7%) had testicular microlithiasis. Three patients had bilateral and 5 had unilateral diffuse TM. No tunica albuginea scars or testis masses were noted. In the 57 patients who underwent direct Immunobead assay no semen sample demonstrated evidence of forming bead-sperm complex, ie none had direct ASA. No patient exhibited evidence of direct ASA. Prepubertal open TBx does not increase the rate of TM. We found no evidence of additive testicular damage associated with TBx at the time of orchiopexy.

THE IMPORTANCE OF MINI-PUBERTY FOR FERTILITY IN CRYPTORCHIDISM

Mini-puberty is the hormonal surge of gonadotropins and testosterone which occurs in early infancy. It induces the development and transformation of gonocytes into Ad spermatogonia, which is impaired in many cryptorchid testes. We examine the role of testosterone in the transformation and development of Ad spermatogonia. A total of 32 patients 1 to 7 years old were treated with human chorionic gonadotropin (HCG) to achieve epididymo-testicular descent before orchiopexy (group 1), and 33 patients underwent orchiopexy without previous hormonal treatment (group 2). A testicular biopsy was obtained during surgery from all the patients. The number of Ad spermatogonia per tubular cross section (Ad/tbx) was assessed and compared between the 2 groups. The number of Ad spermatogonia per tubular cross section in group 1 was also correlated with the post-stimulatory testosterone plasma values. In group 1, 17 patients had greater than 0.1 Ad/tbx, and the remaining patients had 0.1 or less Ad/tbx. In group 2, 6 patients had greater than 0.1 Ad/tbx. Of the boys with cryptorchidism 35% responded inadequately to HCG stimulation, while 10% did not respond. Those patients with suboptimal Leydig cell capacity (and an inadequate response to HCG stimulation) had a defective Ad spermatogonia differentiation of 0.1 or less. Boys with cryptorchidism with an insufficient testosterone surge after HCG risk infertility despite early and successful surgery. The testicular biopsy assists in identifying those who might benefit from hormonal treatment following successful orchiopexy.

THOMAS ANNANDALE AND THE FIRST REPORT OF SUCCESSFUL ORCHIOPEXY

We investigate the surgeon and factors behind the first report of successful orchiopexy. We reviewed the first reports of orchiopexy, and the work and writings concerning Thomas Annandale and the time in which he practiced. Annandale was a surgeon in Edinburgh, Scotland, in the late 19th century. In 1877 he successfully brought down an ectopic testicle in a 3-year-old boy. This first reported successful orchiopexy was due in large part to Lister's antiseptic technique. Annandale performed the first successful orchiopexy by integrating the surgical and antiseptic ideas of his predecessors and contemporaries.

NEOADJUVANT GONADOTROPIN-RELEASING HORMONE THERAPY BEFORE SURGERY MAY IMPROVE THE FERTILITY INDEX IN UNDESCENDED TESTES: A PROSPECTIVE RANDOMIZED TRIAL

Subfertility is considered the principal consequence of cryptorchidism even after timely orchiopexy. Gonadotropin-releasing hormone (GNRH) treatment appears to improve fertility later in life by inducing germ cell maturation. In a prospectively randomized trial we investigated whether preoperative GNRH therapy improves the fertility index in primary cryptorchidism. A total of 42 boys 11 to 100 months old (median 33.5) with 63 undescended testes were prospectively assigned to 2 groups during a 6-month period. Patients were randomized to receive either orchiopexy alone (21 patients) or with neoadjuvant GNRH therapy (21) as a nasal spray for 4 weeks at 1.2 mg per day. In both groups testicular biopsies were performed at the time of orchiopexy and histopathological fertility index was determined. Mean fertility index in the group treated with GNRH before surgery was significantly higher (1.05, SD +/- 0.71) compared to the group without hormonal stimulation (0.52, SD +/- 0.39, p <0.05). The subgroup of neoadjuvant stimulated boys younger than 24 months achieved the best results compared to the age matched boys without hormonal treatment. Neoadjuvant GNRH treatment improves fertility index in prepubertal cryptorchidism. Consequently, preoperative hormone therapy should improve fertility in adulthood. Additionally, the nasal application is well tolerated, safe and already recommended in an adjuvant setting after orchiopexy. Maximum salvage of active germinal tissue is achieved by treating cryptorchidism before the end of the first year of life.

THE INFLUENCE OF ORCHIOPEXY ON SERUM INHIBIN B LEVEL: RELATIONSHIP WITH HISTOLOGY

Since inhibin B is the endocrine marker of spermatogenesis, basal inhibin B levels may reflect germ cell status in children. The aims of this study were to determine the changes in endocrine parameters after orchiopexy in patients with cryptorchidism and to compare these findings with testicular biopsy parameters. A total of 27 boys with undescended testis were included in this study. Inguinal orchiopexy was performed in all patients and 15 underwent testicular biopsy at orchiopexy. Spermatogonia per tubular transverse section and fertility index values were determined. Before and 6 months after orchiopexy serum basal inhibin B and other serum hormone levels were measured in all patients. Mean serum basal inhibin B levels significantly increased 6 months after successful orchiopexy (p = 0.001). However, inhibin B level did not increase in patients who had a low testicular biopsy score. Other reproductive hormone levels did not change after orchiopexy. Basal inhibin B level could be used as a followup parameter after orchiopexy. If basal inhibin B level does not increase in the postoperative period, the amount of germ cells in the testis may be too low or the orchiopexy might not have been implemented appropriately.

Management of cryptorchism and risk of testicular cancer.

Cryptorchism is an established risk factor for testicular cancer, but the role of age at surgical correction is unclear. The authors investigated this relation using information obtained from comprehensive medical records dating to childhood. They conducted a case-control study of 183 Kaiser Permanente members, who were diagnosed with testicular cancer during 1973-1996 and who were 15 years or younger when they first joined the health plan, and 551 controls. Notes pertaining to the testes were reviewed up to the case's diagnosis date or comparable date among the controls. The odds ratio for the association of a history of cryptorchism with testicular cancer risk was 4.8 (95% confidence interval (CI): 1.9, 11.8). Compared with no history of cryptorchism, men with a history who had natural descent or successful orchiopexy by the 11th birthday were not at increased risk of testicular cancer (odds ratio = 0.6, 95% CI: 0.08, 5.4). However, successful treatment of cryptorchism only after the 11th birthday, or never, was related to a 32-fold increased risk (95% CI: 4, 250). Orchiopexy was performed before the 11th birthday on three men who developed testicular cancer but, in each, the procedure failed. In contrast, all four of the early orchiopexies performed on the controls were successful. Boys with failed orchiopexy should be considered for reoperative orchiopexy or orchiectomy to prevent testicular cancer.

TESTICULAR VOLUME DOES NOT PREDICT GERM CELL COUNT IN PATIENTS WITH CRYPTORCHIDISM

A germ cell count of less than 0.2 germ cell per tubule on the prepubertal biopsy of cryptorchid testes predicts abnormal spermiograms and decreased fertility in adulthood, and may be used to select patients for post-orchiopexy hormonal therapy. Testicular volume directly correlates with testicular function and spermiogenesis. We determined whether testicular volume would predict the total germ cell count accurately enough to replace testicular biopsy in the modern management of cryptorchidism. At our hospital 723 patients younger than 9 years with cryptorchidism (unilateral in 619 and bilateral in 104) underwent orchiopexy and bilateral testicular biopsies. These patients had not undergone groin surgery or hormonal therapy previously and had at least 50 tubules in each testicular biopsy. Testicular volume and position, patient age and germ cell counts were analyzed. The generalized estimating equation was used to determine whether a correlation existed between testicular volume and germ cell count. The generalized estimating equation demonstrated a direct correlation between testicular volume and germ cell count. However, germ cell counts predicted from testicular volume varied widely within the 95% confidence intervals. Testes with less than 0.2 germ cell per tubule cannot be reliably distinguished from those with greater than 0.2 germ cell per tubule. Testicular volume does not accurately predict the germ cell count in patients with undescended testes, cannot be used to select patients for post-orchiopexy hormonal therapy and cannot replace testicular biopsy in the modern management of cryptorchidism.

Treatment With a Luteinizing Hormone-Releasing Hormone Analogue after Successful Orchiopexy Markedly Improves the Change of Fertility Later in Life

Purpose Infertility has been considered a principal complication associated with cryptorchidism. A particularly high incidence of cryptorchid boys lack the priming effect during the first 3 months of life due to low concentrations of gonadotropins and testosterone (inadequate perinatal stimulation of the testes, which causes infertility). This condition causes impaired transformation of gonocytes into fetal spermatogonia. More pronounced hypogonadotropic hypogonadism results in fewer germ cells. Most importantly, cryptorchid boys with fewer than 0.2 cells per tubular cross section have a high probability of being infertile in adulthood, regardless of whether the condition is unilateral or bilateral and despite apparently successful orchiopexy. Materials and Methods To counteract the paucity of priming hormones, cryptorchid patients with unilateral or bilateral cryptorchidism and a severe paucity of germ cells were treated with a low dose of the luteinizing hormone-releasing hormone analogue buserelin after successful orchiopexy. We analyzed the spermiograms of these patients, who are now young adults, and compared them to those of 23 other men who also had cryptorchidism with a comparable severe paucity of germ cells but who had not received hormonal treatment after successful orchiopexy. Results Patients who received hormonal therapy after orchiopexy had significantly improved spermiograms compared to those in the control group. Treatment with buserelin increased the number of spermatozoa, improved motility and increased the number of normal forms of spermatozoa. Conclusions The luteinizing hormone-releasing hormone analogue buserelin, administered as a nasal spray every other day for 6 months following successful orchiopexy, appears to have a long lasting, positive effect on germ cells. Consequently, the prognosis of fertility has been greatly enhanced in patients treated with buserelin.

Treatment with a luteinizing hormone-releasing hormone analogue after successful orchiopexy markedly improves the chance of fertility later in life.

Infertility has been considered a principal complication associated with cryptorchidism. A particularly high incidence of cryptorchid boys lack the priming effect during the first 3 months of life due to low concentrations of gonadotropins and testosterone (inadequate perinatal stimulation of the testes, which causes infertility). This condition causes impaired transformation of gonocytes into fetal spermatogonia. More pronounced hypogonadotropic hypogonadism results in fewer germ cells. Most importantly, cryptorchid boys with fewer than 0.2 cells per tubular cross section have a high probability of being infertile in adulthood, regardless of whether the condition is unilateral or bilateral and despite apparently successful orchiopexy. To counteract the paucity of priming hormones, cryptorchid patients with unilateral or bilateral cryptorchidism and a severe paucity of germ cells were treated with a low dose of the luteinizing hormone-releasing hormone analogue buserelin after successful orchiopexy. We analyzed the spermiograms of these patients, who are now young adults, and compared them to those of 23 other men who also had cryptorchidism with a comparable severe paucity of germ cells but who had not received hormonal treatment after successful orchiopexy. Patients who received hormonal therapy after orchiopexy had significantly improved spermiograms compared to those in the control group. Treatment with buserelin increased the number of spermatozoa, improved motility and increased the number of normal forms of spermatozoa. The luteinizing hormone-releasing hormone analogue buserelin, administered as a nasal spray every other day for 6 months following successful orchiopexy, appears to have a long lasting, positive effect on germ cells. Consequently, the prognosis of fertility has been greatly enhanced in patients treated with buserelin.