Is Hormonal Treatment of Congenital Undescended Testes Justified A Debate

Abstract

Abnormal germ cell development in cryptorchidism is not a result of a congenital dysgenesis but is preceded by a hormone imbalance and perturbation in germ cell-specific gene expression during abrogated mini-puberty. Adequate treatment with low doses of GnRHa enables 86% of men to achieve a normal sperm count and, most importantly, prevent development of azoospermia. GnRHa treatment induces a significant transcriptional response, including protein coding genes involved in pituitary development, the hypothalamic-pituitary-gonadal axis, and testosterone synthesis. Furthermore, hormonal treatment to achieve epididymo-testicular descent as a first choice of treatment of cryptorchidism has a long tradition in Europe. It eliminates the necessity of subsequent surgery. Moreover, in the cases of non-responders it facilitates orchidopexy and contributes considerably to a reduced incidence of unilateral and the more serious bilateral complete post-surgical testicular atrophy.

16 years follow-up evaluation of immediate vs delayed vs. combined hormonal therapy on fertility of patients with cryptorchidism: results of a longitudinal cohort study

“…The results obtained in the present series demonstrated that hormonal therapy associated to surgery seems to be able to determine comparative or improved results with respect to surgical treatment alone, although many patients reported low-mild adverse events. Hormonal therapy has been previously confirmed by other authors as mandatory in the treatment of incomplete testes descent because related to a systemic hormonal dysfunction [ 22 ].…”

“…Side effects are more present during hCG therapy such as frequent erections, penile development, pain at the injection site and in the genital region. Cryptorchid testes are characterized by an abnormal testicular histology with a negative association between age and germ cell count except for patients who underwent surgery before 6 months of age who showed > 2.0 germ cells per tubulus ( p < 0.0001) [ 22 ]. However, one out of three boys who early underwent surgery, presented an abnormal sperm count (< 40 × 10 6 ) after 20 years and four of them had azoospermia [ 23 ].…”

Fertility of Cryptorchid Testis—An Unsolved Mistery

“…The exposure of the UDT to high temperature was incriminated as a factor that damages the gonads before the completion of sexual maturation, but recent data are consistent with the idea that infertility due to cryptorchidism caused by germ cell loss is a consequence of alterations in the P-element-induced wimpy testis (Piwi) pathway and transposon de-repression [ 19 ]. Germ cell death and genomic instability, due to uncontrolled transposon activity, could explain the decreased germ cell count identified in boys with cryptorchidism.…”

Ist die Hormontherapie bei Hodenhochstand noch zeitgemäß?

“…Die gelegentliche Aussage von Befürwortern der Hormontherapie, dass bei ausbleibendem Erfolg der Hormontherapie die nachfolgend erforderliche Operation erleichtert würde [9], ist mit keiner Studie belegt. In mehreren prospektiven Studien ließ sich vielmehr zeigen, dass im Falle eines Nicht-Ansprechens auf eine hCG-Therapie anatomische Ursachen verantwortlich gemacht werden können, die einen auch hormonell induzierten Deszensus mechanisch verhindern (u. a. Anheftung des Gubernaculums im oberen Skrotalfach).…”