Testicular Descent: When to Interfere?

Abstract

Spontaneous descent of testes after birth can occur in up to 70% of cases, yet the factors contributing to it are still controversial. This study aims to evaluate factors contributing to spontaneous descent of palpable undescended testes. Eighty-four newborns with 126 palpable undescended testes (42 unilateral and 42 bilateral) were followed up for a period of one year to study the occurrence and time of testicular descent and its relation to gestational age, birth weight, uni- or bilaterality and levels of FSH, LH and testosterone. A total of 58 testes (46%) descended between 3 and 6 months. Spontaneous descent occurred in 10 premature patients (14 testes 63%) compared to 44 testes of full-term patients (43%). Descent occurred in 14 unilateral undescended testes (33%) compared to 44 (52%) in bilateral cases. In patients with spontaneous testicular descent there was postnatal peak of LH and testosterone at 2 to 3 months of age which returned to basal level at 6 months of age. In patients with permanent undescended testes the peak of LH and testosterone was very low and almost absent in some of them; no significant difference was found between the mean values of FSH in both groups. No spontaneous testicular descent occurred after the 4th month in the full-term group, whereas in the pre-term group spontaneous descent occurred up to 6 months of age. This study concluded that spontaneous descent of palpable undescended testes is closely related to the presence of LH and testosterone surge. Therapy of undescended testes should start at 4 months of age in a full-term baby and at 6 months of age in a pre-term baby.

Systematic review and meta-analysis comparing outcomes following orchidopexy for cryptorchidism before or after 1 year of age

“…Their conclusion was that the optimal time to perform orchidopexy was between 6 and 12 months of age, as this was considered to maximize fertility potential and minimize malignancy risk, whilst also allowing for the spontaneous descent of the cryptorchid testis, which is reported to occur most commonly before the age of 6 months46. Their review was, however, broad in its scope, looking at general trends in the impact of age on outcome, as opposed to exploring the impact of performing orchidopexy before a specific age cut‐off.…”

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

“…In this study only two patients; one of each group had their testis located in the abdomen, therefore the study is comparable also with regard to testicular position found at surgery. In male gonadotropin secretion which increases from 2 to 4 months after birth stimulating Leydig cells to secrete testosterone (12)(13)(14). Testosterone increase is blunted in cryptorchid boys (13,14).…”

“…In male gonadotropin secretion which increases from 2 to 4 months after birth stimulating Leydig cells to secrete testosterone (12)(13)(14). Testosterone increase is blunted in cryptorchid boys (13,14). This insufficient testosterone secretion is responsible for impaired transformation of gonocytes into Ad spermatogonia (4,5,11,(15)(16)(17).…”

Acquired Cryptorchidism: What Should We Know? The Results of a Systematic Review

“…They found that a 77.7% has a tendency of spontaneous descent at puberty, and in nearly all cases, after spontaneous descent or after pubertal orchidopexy, with long-term testicular volumes appropriate for age. Pubertal surges in luteinizing hormone and testosterone, as also is seen in the first 3 months after birth (Hamza AF et al 2001) when spontaneous descent of congenital UDT can still occur, are hypothesized to be responsible for pubertal spontaneous descent (Sijsterman K et al 2006).…”