The Effectiveness of hCG and LHRH in Boys with Cryptorchidism: A Meta-Analysis of Randomized Controlled Trials

Abstract

To systematically review the efficacy of hCG and LHRH on testicular descent in boys with cryptorchidism, comprehensive search was performed to identify randomized controlled trials (RCTs) in PubMed, EMBASE, the Cochrane Library, Wanfang Database, and China National Knowledge Infrastructure (CNKI) up to March 2014. Outcomes included testicular complete descent rate (TCDR) and cure rate of patients. Study quality was evaluated using the Jadad scale. Meta-analysis was performed using Review Manager software. Finally, 13 studies were included. hCG and LHRH increased TCDR comparing with control group. The success rate of hCG and LHRH was 24 and 19%, respectively. Further, hCG and LHRH had significant effect on bilateral cryptorchidism, but not on unilateral cryptorchidism. All side effects were transitory and not severe, but if they have long-term harms were not clear. hCG and LHRH can effectively increase TCDR and there was no significant difference between them. However, the hormones cannot be recommended for everyone because of their low success rates and potential long-term harms. Further studies are needed to determine the efficacy of hormonal treatment for subtypes of cryptorchidism.

Hormonal Aspects of the Pathogenesis and Treatment of Cryptorchidism

“…human chorionic gonadotropin (hCG) increased the rate of complete testicular descent significantly compared with the control group (24 vs. 8%). The same was found for GnRH (19 vs 50 In long-term follow-up, 24% (95% CI, 13-35%) of the testes that descended in connection with GnRH treatment reascended. 14 In the majority of the studies, however, the follow-up period was short.…”

“…14 Preoperative hormonal therapy has the advantage of distinguishing between congenital undescended testes and retractile or ascending testes. 49 Bu et al 50 reviewed 142 studies of hormonal treatment for testicular descensus and included 13 randomized trials published up until 2014 in a meta-analysis. The overall success rates reported by the 13 randomized control trials ranged from 8 to 55%.…”

“…Bu et al concluded that better planned and executed studies are needed to determine the real benefit of hormonal therapy in treatment of testicular descensus. 50…”

European Association of Urology Guidelines on Male Sexual and Reproductive Health: 2021 Update on Male Infertility

“…The degeneration and decline of germ cells in cryptorchidism occur within the first year of life and therefore surgery has been advocated within 12 mo of birth to mitigate this risk [106], while early orchidopexy improves sperm counts [107][108][109] and reduces the risk of testicular cancer in adulthood [110]. The gold standard treatment for cryptorchidism is orchidopexy, and metaanalyses have revealed that hormone stimulation therapy as a primary treatment modality has poor success rates [111,112]. Paternity rates among men with a history of unilateral cryptorchidism are almost equivalent to those for men without cryptorchidism, but a background of bilateral cryptorchidism confers a paternity rate of 35-53% and men should be counselled accordingly [113].…”

Treatment of gonadotropin deficiency during the first year of life: long-term observation and outcome in five boys

“…It is also important to acknowledge that it is not known whether increasing the intratesticular testosterone with LH or hCG would produce more sustainable results in terms of Sertoli cell function. Furthermore, controversy exists on whether hormonal intervention (GnRH, hCG or LH) should be considered for bilateral cryptorchidism in CHH patients, although the Nordic consensus recommends surgical treatment (Ritzén et al , 2007; Bu et al , 2016; Lambert and Bougneres, 2016). All of the five patients in this series treated with r-hFSH and T required bilateral orchiopexy, three of them due to ascent of the testes.…”