Epidemiology, Classification and Management of Undescended Testes: Does Medication Have Value in its Treatment?

Abstract

Genetic, hormonal, and anatomical factors are believed to be involved in the etiology of undescended testes. Due to increased risk of infertility, testicular cancer, torsion and/or accompanying inguinal hernia (>90%) as well as cosmetic concerns, all these patients require treatment. In this review paper, we aimed to evaluate the success rates of treatment modalities used in undescended testes, beginning from 1930 to the present, and to draw attention to the possible risks and benefits and also the efficacy of hormonal therapy in the management of the disorder, which is still a controversial issue. Hormonal therapy may lead to penile growth, painful erection, and behavioral changes while on treatment. In recent years, it has been reported that human chorionic gonadotropin (hCG) treatment was associated with interstitial edema due to increased vascular permeability, inflammation-like changes, and several adverse effects on germ cells by increasing pressure and apoptotic process. It has also been reported that LHRH analogues have positive effects on germ cells by increasing fertility in patients undergoing unilateral or bilateral orchiopexy. In some studies, the success rate of hCG treatment was reported to be higher following buserelin. In some other studies, hCG treatment was recommended before orchiopexy to reduce the risk for surgical ischemia. There are a limited number of randomized controlled studies, so evidence showing the efficacy of hormonal therapy is insufficient. According to the 2007 Consensus Report of Nordic countries, it is recommended that surgery is the first-line treatment modality in undescended testes and that it should be performed by pediatric surgeons and urologists at the age of 6-12 months. Conflict of interest:None declared.

Maternal Gestational Smoking, Diabetes, Alcohol Drinking, Pre-Pregnancy Obesity and the Risk of Cryptorchidism: A Systematic Review and Meta-Analysis of Observational Studies

“…The descent of the testes normally occurs in two stages; a transabdominal stage at 7 to 15 weeks [ 52 ] and a transinguinal stage [ 6 ] at 20 to 35 weeks of pregnancy [ 52 , 53 ]. Insulin-like peptide (INSL3), anti-Mullerian hormone (AMH), human chorionic gonadotropin (HCG), androgens and their receptor genes are all involved in these events [ 6 , 53 , 54 , 55 ]. Any factors that can influence the levels of these hormones may affect descent of the testes.…”

“…Previous studies [ 56 , 57 ] found that maternal gestational smoking is associated with reduced levels of intact HCG and desert hedgehog (DHH) signaling in newborn males. HCG is needed for testicular descent and is used as a hormone treatment for cryptorchidism [ 6 ]. The effect of maternal gestational smoking on cryptorchidism risk may be mediated by reduction in HCG levels.…”

“…It has a prevalence of 1.63 to 2.90% [ 1 , 2 ], and in approximately 70% of affected infants, the testes spontaneously descend during the first 3 to 6 months after their birth [ 3 – 5 ]. Nearly 20% of undescended testes are impalpable [ 6 ]. Cryptorchidism can be treated surgically or by hormone therapy, and may have severe long-term complications if untreated.…”

Ontogeny of Hypothalamus-Pituitary Gonadal Axis and Minipuberty: An Ongoing Debate?

“…Despite apparent success in individual patients, the possibility of unrelated spontaneous descent of retractile testes cannot be excluded in the absence of randomization and the effect does not seem sufficiently powerful to justify routine clinical use. However, targeted neonatal treatment for cryptorchid boys with absent minipuberty might reveal significantly higher success rates (75,76). Table 1 summarizes available studies on gonadotropin treatment in order to replace minipuberty in infants with congenital hypogonadotrophic hypogonadism (77)(78)(79)(80)(81)(82)(83).…”

Utilization of scrotal orchidopexy for palpable undescended testes among surgeons

“…[ 1 ] The testis descends to the scrotum in 75% of full-term neonates and 90% in premature newborns. [ 2 3 ] There are two surgical approaches to correct palpable undescended testicle (UDT) – first, there is the traditional inguinal approach, and second, there is the scrotal orchidopexy approach, which was introduced in 1989 by Bianchi and Squire although it is still not a popular choice as far as surgeons are concerned. [ 4 ] The scrotal approach was found to have a lower morbidity rate, with a shorter hospital stay, shorter operation times, and less-associated pain.…”