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

INTRODUCTION: 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. MATERIALS AND METHODS: 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 µg 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. RESULTS: All males in the untreated group were severely oligospermic, with 20 percent being azoospermic. In contrast, 86 percent 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). CONCLUSION: 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.

Structural analysis of gubernaculum testis in cryptorchid patients submitted to treatment with human chorionic gonadotrophin

OBJECTIVES: To make a histological and stereological analysis of gubernaculum testis elastic system fibers, collagen and striated muscle cells in patients with cryptorchidism treated with human chorionic gonadotrophin (hCG). MATERIALS AND METHODS: Gubernacula tissue samples were obtained from 12 patients with cryptorchidism. Patients' ages ranged from 1 to 3 years (mean 1.8). Of the 12 patients, 6 were treated with hCG. The samples were stained with Masson's trichrome to highlight muscle fibers and collagen, and Weigert's resorcin-fuchsin to highlight the elastic system fibers. The volumetric density of these components was determined by stereological methods. RESULTS: The volumetric density of collagen was increased in patients treated with hCG, ranging from 85.62 percent to 94.48 percent, while in patients not submitted to hCG treatment the volume density ranged from 52.12 percent to 89.46 percent (p = 0.0052). The volumetric density of the elastic system fibers was higher in patients treated with hCG, ranging from 9.62 percent to 19.62 percent, while patients not submitted to hCG treatment the volume density of elastic system fibers was between 10.38 percent and 12.38 percent (p = 0.0030). The volume density of striated muscle fibers in patients treated with hCG ranged from 4.76 percent to 39.16 percent, while and in patients not treated hCG it ranged from 3.24 percent to 11.14 percent (p = 0.0052). CONCLUSION: Gubernacular components alter significantly when submitted to treatment with hCG. Patients who underwent hCG treatment and had no complete testicular migration had an increase in the concentration of elastic and striated muscle fibers and a decrease in the volumetric density of collagen.

Stereological and morphometric analysis of collagen and seminiferous tubules in testes of patients with cryptorchidism submitted or not to treatment with human chorionic gonadotrophin

OBJECTIVES: Quantify the distribution of collagen and analyze the seminiferous tubules diameter in the testis of patients with cryptorchidism, to verify if the previous use of human chorionic gonadotrophin (hCG) affects these structures. MATERIALS AND METHODS: Samples of parenchymal tissue of cryptorchid testis obtained during peroperative biopsies were collected from 26 patients. Sixteen samples were embedded in paraffin and stained with picrosirius red to evidence fibers of collagen system. The quantification of these fibers was determined by stereological methods, using a test system M-42. To obtain seminiferous tubules diameter we used 10 of the 26 samples. These samples were embedded in Epon and the analyses were carried out in semi-thin sections, stained with toluidin blue. The selected results of each group were statistically analyzed and compared by the student's t and Tukey-Kramer's tests. RESULTS: The testicular interstitium and lamina propria of patients treated with hCG showed statistically significant less collagen system fibers, when compared to the testes of patients nontreated (0.30 percent versus 0.39 percent, p = 0.0079). The seminiferous tubules diameters were not statistically significant different between the testes of patients treated and nontreated with hCG (67.5 versus 59.35 µm, p = 0.0609). CONCLUSIONS: hCG use in the cryptorchidism could delay, at least temporarily, a progressive growth of fibers of collagen system. We did not find statistically significant difference in the seminiferous tubular diameters between treated and nontreated patients.

Utilidad de la gonadotropina coriónica humana en criptorquidia / Usefulness of human chorionic gonadotrophin in the treatment of cryptorchidism

Para evaluar el tratamiento de la criptorquidia mediante gonadotropina coriónica humana, se estudio una cohorte en la cual se tuvo especial cuidado de no incluir pacientes con testículos retráctiles. A todos se les aplicó 10 mil Ul de gonadotropina coriónica humana intramuscular en un lapso de dos semanas; los efectos fueron analizados al primer y al cuarto mes de la última dosis. La población estudiada estuvo integrada por 68 pacientes con un total de 82 testículos no desendidos; sus edades oscilaron entre uno y 14 años; 42 de las gónadas eran derechas (51.2 por ciento), 40 izquierdas (48.4 por ciento); 15 eran impalpables (18.3 por ciento), una se hallaba ectópica en periné mientras que las restantes 66 se ubicaban en posición distal al anillo inguinal externo; ocho testículos mostraban hipotrofia marcada (11.9 por ciento). Un mes después de aplicar la gonadotropina coriónica humana siete gónadas (8.5 por ciento) se encontraron ubicadas en el escroto mientras que 11 (13.4 por ciento) se aproximaron a la bolsa, sin alcanzarla totalmente. A los cuatro meses sólo cinco permanecían en el escroto (6 por ciento) y siete aproximadas a la bolsa escrotal (8.5 por ciento). Sólo una gónada mostró mejoría en su trofismo (1.1 por ciento) pero ningún testículo impalpable se hizo clínicamente aparente. Al final sólo cuatro pacientes (5.8 por ciento) pudieron evitar la intervención quirúrgica. Se concluye que el tratamiento de la criptorquidia con gonadotropina coriónica humana es útil en un porcentaje bajo, pero significativo

[Place of the hormonotherapy by HCG in treatment of ectopia testis in children]

Although cryptorchidism is known since the antiquity, some of its aspects are still not very clear and its treatment, particularly by hormone doesn't realize the unanimity. In order to codify the indication of HCG in cryptorchidism, a prospective study has been realized at the Infant Surgical Clinic of the Hospital Center lbn Rochd of Casablanca. This study concerned also a group of children treated in a "non codified" way since 1988, in order to analyse better the correlation between clinic and surgery. This study concerned 415 children with 528 ectopia testis. 318 of them have been treated with HCG, 6000 to 12000 UI according to the age. The whole success of hormonotherapy has been about 41%. The parameters that conditionned this success are: the age of the child [children older than 6 have had a better result], the seat of the testis [the lower was the testis, the easier was the success], the testicular mobility and the absence of the peritoeal process. In the case of unsuccess of the hormonotherapy, the surgical act permitted to notice aperirtoneal process undiagnosed clinically [95%], a gubernaculum testis high inserted [95%], a short spermatic pedicle [10%] or an non permeable inguinoscrotal duct [35%]. The analysis of this series and data of litterature permits to recommend HCG in the children from 2 to 10 years old, of whom the testis is palpable, without peritoneal process and with a notable mobility of testis. The other cases must belong to the surgery

Opcao da hormonioterapia como tratamento da criptoquia / Option of the hormonitherapy with treatment of the cryptorquism

No periodo compreendido entre janeiro de 1979 121 paci-entes portadores de criptorquia uni ou bilateral, foram submetidos a hormoniote-rapia com gonadotrofina corionica humana (HCG). O numero total de testiculos es-tudados foi de 146, sendo a criptorquia direita em 45 pacientes (37,1%), criptorquia esquerda em 51 (42,1%) e bilateral em 25 (20,6%). O estudo em questao apre-senta resultados proximos aos da literatura mundial e sugere o uso da estimula-cao hormonal como tratamento inicial das distopias testiculares, reservando otratamento cirurgico para os casos de falha da hormonioterapia.

Hormonal therapy in undescended testes.

A clinical study trial of HCG therapy in 78 selected prepubertal cryptorchids (40 unilateral and 38 bilateral) having a total of 116 undescended gonads revealed that complete descent occurred in 12.5% gonads (13% in unilateral and 12% in bilateral group). Good response was observed in only those gonads which were located in the inguinal canal and at the external ring, irrespective of it being right or left sided gonad. In patients with impalpable testes, though there was no complete descent, yet partial descent was noted in 18% (21/116 gonads). The response was better in the older children.

Estudio y manejo de la criptorquidia: gonadotropina y orquidopexia / Study and management of cryptorchism: gonadotropin and orchidopexy

En el tratamiento del testículo criptoquídico ha habido siempre controversia para decidir la conducta que puede preservar la fertilidad del órgano y evitar repercusiones psicológicas y la degeneración maligna, todo lo cual fundamentalmente gravita sobre la edad en que debe aplicarse orquidopexia y el uso de la gonadotropina coriónica. Este estudio presenta una serie de 105 pacientes tratados desde los dos años de edad con gonadotropina coriónica y orquidopexia en la cual se obtienen resultados muy satisfactorios, semejantes a los que han descrito otros autores siguiendo una conducta parecida. Es importante difundir este criterio de manejo integral para evitar la atrofia testicular y confirmar que la gonadotropina coriónica puede provocar el descenso a escroto o facilitar la orquidopexia quirúrgica

Criptorquidia: distopia testicular / Cryptorchism: testicular dystopia

Analisam-se os conceitos atuais referentes aos aspectos básicos que regulam o tratamento da distopia testicular. Säo salientados a conveniência do tratamento da anomalia no segundo ano de vida, bem como os critérios que indicam sua correçäo cirúrgica ou manipulaçäo hormonal

Resultados del tratamiento con gonadotrofina coriónica en niños con criptorquidia / Results of treatment with chorionic gonadotropins in children with cryptorchidism

Se estudiaron 124 niños entre 7 meses y 13 años de edad, con diagnóstico de criptorquidia de varios tipos y grados. Todos ellos fueron sometidos a tratamiento con gonadotrofina coriónica en una dosis total de 10,000 UI, dividida en cuatro dosis de 2,500 UI cada una. Los pacientes fueron reexaminados 15 días de terminar el tratamiento considerándose éxito total cuando ambos testículos se encontraron en escroto y éxito parcial cuando sólo uno de ellos descendió. Se obtuvo un éxito total en 27.4% de los pacientes en general. Una serie de factores parecen influir en el éxito del tratamiento, como: tamaño de los testículos, grado de criptorquidia y edad de los pacientes