The volume of unilaterally undescended testis afterhCGtherapy compared to orchidopexy and combined methods

Abstract

The aim of the study was to compare the effects of human chorionic gonadotropin (hCG) therapy with those of surgical or combined therapy on testicular volume (TV) in boys at different ages with unilateral canalicular undescended testis (UDT). In total, 155 boys aged 1 to 12 years were treated: either surgically (ST), or by 50 IU/kg body weight hCG administration every three days for five weeks (HT), or by a combination of the two. The patients underwent ultrasound examination of TV before the treatment, 9-12 (median 10) and 24-39 months (median 32) after therapy. The testicular atrophy index (TAI) of the affected testicle was calculated. The success rate was 94.7% for ST, 39.2% for HT and 98% for HST patients. The atrophy rate was 5.3% for ST, 0% for HT and 2% for HST. Neither treatment type nor patient age significantly influenced gonadal atrophy. No significant differences in TV of the affected testis were observed after treatment between the groups. The TAI values were significantly the lowest in HT group (p = 0.0006). Both TV and TAI changes from the baseline values did not differ between the treatment groups. At the 24- to 39-month follow-up, no significant differences were observed in the change in baseline TV and baseline TAI between age groups. TV of the affected testis increased significantly (p = 0.0000), and TAI decreased significantly over time (p = 0.01), with no significant differences depending on the age group, treatment type or the interaction of the two factors. The hCG therapy did not impair the development of affected and healthy testes, neither as single nor as neoadjuvant therapy, both during early assessment and after 2-3 years. Patients' age at the initiation of treatment seems irrelevant.

Testicular Temperature and the Effects of Orchiopexy in Infants with Cryptorchidism

“…19 Using the formula reported by Niedzielski et al, our results were similar, indicating the accuracy and reproducibility of the USG measurement. 20 Kuijper et al reported that the mean testicular volume in 0-year-old to 6-year-old boys increased from 0.27 cc to 0.44 cc in the first 5 months of life, 21 indicating that USG can detect subtle but significant changes in testicular volumes during the infantile period, and our results are consistent with such subtle but significant changes (table 1).…”

The effect of the two-stage laparoscopic Fowler-Stevens operation on testicular growth and risk of atrophy in boys with intra-abdominal testes

“…Precise evaluation of the degree of testicular atrophy determines further treatment in a number of patients. In our opinion, reliable assessment can only be done using TV and TAI calculated on the basis of the ultrasound recordings [ 2 , 25 ]. Thanks to this precise assessment we were able to reveal that the volume of testes submitted to 2SLF-SO increased with advancing age, while the difference in volume between the healthy and undescended testis decreased to only 5% at the age of 7–9 years.…”

Open controversies on the treatment of undescended testis: An update

“…The theoretical basis of hormone treatment for cryptorchidism is that hypothalamic–pituitary–gonadal (HPG) axis hormone deficiency can lead to cryptorchidism, whereas human chorionic gonadotropin (hCG) and gonadotropin-releasing hormone (GnRH) can stimulate the synthesis of testosterone and promote the testicular descent to the scrotum ( 29 , 30 ). Many studies have shown that hCG therapy and luteinizing hormone-releasing hormone (LHRH) or GnRH therapy are more effective in the hormone treatment of cryptorchidism ( 31 , 32 ). The effect of hCG on testicular stromal cells can promote testosterone synthesis.…”