Clinical, physical, sperm and hormonal data in 251 adults operated on for cryptorchidism in childhood

Abstract

Objective To determine the clinical, physical, sperm and hormonal status during adulthood in cryptorchid patients operated on during childhood, and to assess these variables according to the age at surgery and preoperative testicular position. Patients and methods A letter was sent to all 890 patients > 18 years old who underwent surgery for cryptorchidism during childhood; 274 responded and were assessed using a sexual history, physical examination, pituitary axis study and sperm analysis. Data were complete for 251 patients (mean age 21 years, range 18±30); 196 had unilateral (25 anorchic) and 55 had bilateral cryptorchidism. Clinical, surgical and anatomopathological records at surgery during childhood were also reviewed. Results The mean (SD) age at orchidopexy was 6.4 (3.3) years and the mean age at assessment 21.1 (2.7) years. Semen samples generally showed abnormalities; 10 patients (4%) with bilateral and 57 (23%) with unilateral cryptorchidism had semen values within the normal range. There was no correlation between the sperm count and age at surgery for unilateral or bilateral cases (Spearman test). There was a signi®cant correlation (r = x 0.41) between the sperm count and level of folliclestimulating hormone (FSH). There were no signi®cant differences in the sperm count for patients with different testicular locations (ANOVA) or in those treated or untreated with human chorionic gonadotrophin (Student's t-test). The only signi®cant relationship (P < 0.001) was between the sperm count and unilateral or bilateral cryptorchidism. Conclusions The sperm quality of adults operated on for cryptorchidism during childhood is independent of the age at surgery or testicular location, but is in¯uenced by whether the cryptorchidism was unilateral or bilateral. FSH levels were negatively correlated with sperm density.

Fertility potential in men with a history of congenital undescended testes: a long‐term follow‐up study

“…Although some studies have suggested that orchiopexy at younger age results in better semen parameters (Canavese, 2009;Engeler, 2000;Taskinen, 1996) results of this study show no favourable effect of early treatment on semen characteristics, in line with other studies (Coughlin, 1999;Gracia, 2000;Lee & Coughlin, 2001;Vinardi, 2001). No study which evaluates age at surgery as a continuous variable finds statistically significant correlations with semen parameters (Coughlin, 1999;Gracia, 2000;Lee & Coughlin, 2001;Vinardi, 2001).…”

“…Men with a history of bilateral UDT face more fertility problems than do men with previously unilateral UDT (Gracia, 2000;Taskinen, 1996). In this study, sperm concentration was significantly lower in patients with bilateral UDT (Mann-Whitney U test).…”

“…The inclusion rate in other studies varied between 29 and 73% (Canavese, 2009;Cortes & Thorup, 1991;Cortes, 1996;Engeler, 2000;Gracia, 2000;Taskinen, 1996). Three studies had a higher number of participants than our study of (Cortes & Thorup, 1991;Coughlin, 1999;Gracia, 2000).…”

“…Many studies have been published on semen parameters in patients with UDT. Such studies are not always easy to compare because of several reasons; (i) different therapeutic strategies, (ii) variation in reporting the results (mean values, median values or percentage normal/abnormal), (iii) the WHO-reference values for semen analysis have changed over time, (iv) uncertainty whether groups contain only congenital UDT or also acquired UDT, (v) groups may contain unilateral or bilateral UDT or a combination of both, (vi) unclear about the exclusion of retractile testis (Canavese, 2009;Cortes & Thorup, 1991;Cortes, 1996;Coughlin, 1999;Engeler, 2000;Gracia, 2000;Lee & Coughlin, 2001;Taskinen, 1996;Vinardi, 2001). In this study, men with retractile testis or acquired UDT were excluded and this might be an explanation for our low sperm concentration in comparison with the literature.…”

“…No study which evaluates age at surgery as a continuous variable finds statistically significant correlations with semen parameters (Coughlin, 1999;Gracia, 2000;Lee & Coughlin, 2001;Vinardi, 2001). Two studies found an effect of age at surgery for patients with bilateral UDT, but not for unilateral UDT (Engeler, 2000;Taskinen, 1996).…”