Der optimale Zeitpunkt der Behandlung des Kryptorchismus

Ludwig, G.; Potempa, J.

doi:10.1055/s-0028-1106278

Cited by 94 publications

(27 citation statements)

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“…hCG is known to induce Leydig cell differentiation and stimulate the production of testosterone [2]. Lackgren and Ploen did not find any morphological signs of maturation in the germ cells or Sertoli cells after five weeks of hCG-treatment [22]. This is in contrast to reports of the differentiation of Sertoli cells and the transformation of germ cells to primary spermatocytes after long term (3-6 months) hCG-treatment [2, 261.…”

Section: Germ Cell Adenylyl Cyclasecontrasting

confidence: 54%

Germ Cell Adenylyl Cyclase Activity in the Human Undescended Testis and the Effect of HCG-Treatment

Läckgren

Gordeladze

Plöen

et al. 1984

Archives of Andrology

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In the present study we have examined the soluble Mn?' dependent, germ cell specific adenylyl cyclase (AC) activity and germ cell morphology in testicular biopsies from twenty-three boys, aged 2-17 years, with undescended testes and three adult men with normally descended testes. Eight of the boys were treated with hCG immediately before surgery. Germ cell AC-activity (3.2-3.4 pmoles cAMP/rng proteinhin) was found in the adult testes with normal germ cell morphology. Furthermore, low but significant AC-activity (0.2-0.8 pmoles cAMP/mg proteinhin) was noted in biopsies containing only primary spermatocytes. There was no Mn2+ dependent AC-activity in Sertoli cell only testes or in testes where only spermatogonia were observed. Treatment with hCG did not influence germ cell maturation or soluble Mn2+ dependent AC-activity.

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Section: Germ Cell Adenylyl Cyclasecontrasting

confidence: 54%

Germ Cell Adenylyl Cyclase Activity in the Human Undescended Testis and the Effect of HCG-Treatment

Läckgren

Gordeladze

Plöen

et al. 1984

Archives of Andrology

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“…Ludwig and Potempa [8] found that the fertility rate is inversely proportional to the age of the patient at the time of operation with best results being noted in those unilateral cryptorchid men operated upon during the first or second year of life. This 1975 study led to the conclusion that the optimal time for operating on testicular maldescent is (at the latest) the end of the second year of life.…”

Section: Discussionmentioning

confidence: 99%

Infertility in Cryptorchidism Is Linked to the Stage of Germ Cell Development at Orchidopexy

et al. 2007

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Background: Cryptorchidism represents the most common endocrine disease in boys, with infertility frequently observed in unilateral as well as bilateral forms. In this study, we examined the role of Ad (dark) spermatogonia for fertility in cryptorchid boys. The hypothesis to be proven was that boys lacking Ad spermatogonia will develop infertility despite a successful orchidopexy at an early age. Methods: To estimate total sperm count, one of the most predictive parameters of male fertility, we analyzed the ejaculatein 218 cryptorchid men and correlated it with the developmental stage of their germ cells at the time of successful surgery. Results: Abnormal sperm concentration (<40 × 10⁶/ejaculate) was found in half of the patients under the study. 47.5% of unilateral and 78% of bilateral cryptorchid males had their sperm concentration in the infertility range according to the WHO standards. If transformation into Ad spermatogonia had occured, age-related differences in the fertility outcome was observed. The younger the unilateral cryptorchid boys were at surgery, the higher their sperm count. Age-related difference was not found in the group of cryptorchid men having had no A dark spermatogonia at time of surgery, indicating that in this group a successful orchidopexy is insufficient to prevent infertility development and, in particular, the development of azoospermia. Conclusion: The presence of Ad spermatogonia at surgery is an excellent prognostic parameter for future fertility. Cryptorchid boys lacking these cells will develop infertility despite successful orchidopexy at an early age.

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“…These studies originated from the time when treatment was given relatively late, which may be the reason why semen quality was so poor and why treatment had a positive influence in only 25% of bilateral cases and showed no effect in those who had a unilateral undescent. In studies involving children operated on before the age of 3 or 6 years, orchidopexy has been associated with positive effect on semen quality [42, 44, 45]. Treatment of a unilateral undescended testis at the postpubertal age is associated with azoospermia or oligozoospermia in 85% of cases [46].…”

Section: Pathology In Maldescended Testesmentioning

confidence: 99%

Maldescendus testis

Toppari¹,

Kaleva²

1999

Horm Res Paediatr

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Maldescendus testis is a common congenital abnormality occurring in 2–5% of full-term boys at birth in the Western countries. By 3 months of age, the incidence rate spontaneously reduces to 1–2% in this group. The etiology of the disorder is not known, but normal hypothalamo-pituitary-gonadal axis is usually a prerequisite for normal descent of the testes. Abnormal sexual differentiation is associated with maldescent. However, the majority of boys with maldescended testes show no endocrine abnormalities after birth. Several defects in developmental genes, such as homeobox genes and Insl3, have been described to cause cryptorchidism in mice, and disturbances in the regulation of these genes or their mutations may explain etiology of a large part of human testicular maldescent in the future. Increased degeneration of germ cells can be observed in undescended testes after the first year, and therefore early treatment is recommended. Surgical treatment is the most effective and reliable method to bring testes into the scrotum, but hormone treatment with either hCG or GnRH analogues can be considered, particularly in cases where testes can be palpated in high scrotal position. The efficacy of hormone treatment is less than 20% and depends on the initial location of the testis. Nonpalpable testes rarely descend with hormone treatment. Both surgery and hormone treatment can have untoward effects. Treatment with hCG has been associated with an inflammation-like reaction in the testes and an increased rate of apoptosis of germ cells leading to a reduced adult size of the testes. Vascular complications can occur during surgery, particularly in staged orchidopexies. Men with a history of undescended testis have an increased risk of testicular cancer. Impaired fertility is another long-term risk associated to maldescended testes. Fertility potential may be improved by early treatment. Although our knowledge on cryptorchidism has increased considerably during the last decades, many questions remain to be answered: Is the incidence rate increasing? What is causing maldescent? Do hormones have any role in the treatment?

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Der optimale Zeitpunkt der Behandlung des Kryptorchismus

Cited by 94 publications

References 0 publications

Germ Cell Adenylyl Cyclase Activity in the Human Undescended Testis and the Effect of HCG-Treatment

Germ Cell Adenylyl Cyclase Activity in the Human Undescended Testis and the Effect of HCG-Treatment

Infertility in Cryptorchidism Is Linked to the Stage of Germ Cell Development at Orchidopexy

Maldescendus testis

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