Effect of a Combined GnRH/HCG Therapy in Boys with Undescended Testicles: Evaluated in Relation to Testicular Localization within the First Week After Birth

Abstract

Among 509 boys referred with undescended testicles, 112 had true undescended testicles unilaterally and 62 bilaterally. Patients with true undescended testicles were offered hormonal treatment unless the condition was associated with hernia or previous operations. Boys less than 5 years old were primarily treated with gonadotrophin releasing hormone (GnRH), while boys more than 5 years old were primarily treated with human chorionic gonadotrophin (hCG). If the effect of the primary treatment was insufficient the other hormone was given. Testicular descent was obtained for 64% (23/36) of the intraabdominally located testicles in boys with bilaterally undescended testicles versus only 14% (3/21) in boys with unilaterally undescended testicles (p < .001). Treating 1 to 4 years old boys with GnRH resulted in descent in 16 of 95 testicles and secondary treatment with hCG yielded an additional 34, whereas secondary treatment of 5 to 13 years old boys with GnRH added only 10 descended testicles to 51 of 101 testicles. Reading the maternity records of 272 of the boys support other studies showing that testicles may reascend. Boys with endocrinological or "surgical" causes of incomplete testicular descent were relatively more likely to have had one or two undescended testicles during the first postnatal week compared with boys found to have only retractile testicles (p < .001). Treatment with hormones resulted in descent in 56% of boys whose testicles were both descended within one week after birth. Conversely, only 1 of 20 boys with unilateral testicular undescent postnatally was sufficiently treated with hormones (p < .001). The hormonal effect in boys with bilaterally undescended testicles at delivery did not differ significantly from boys with either one or none undescended testicle postnatally. In 35 of 51 boys (69%) in whom the hormonal effect was insufficient, operation revealed a "surgical cause" of the incomplete testicular descent.

Long-Term Outcomes of Retractile Testis

“…However, proof of the efficacy of hormonal therapy for undescended testis is limited as yet. There was a report that the practice of hormone therapy for less than 1 week was almost not effective for boys with unilateral undescended testis although it was found to be effective in about 56% of boys with bilateral undescended testis [25]. A number of studies have been conducted regarding hormone therapy among patients with retractile testis, and testicular descent was achieved by short-term hormone therapy.…”

Germ cell development in the descended and cryptorchid testis and the effects of hormonal manipulation

“…The studies generally agree with Pyorala et al [78] that therapeutic success is greater when the testis is in a lower position and age is not a factor. In addition, four trials reported that it is more effective in bilateral cases rather than unilateral ones [81][82][83][84].…”

Hormonal Treatment for Unilateral Inguinal Testis: Comparison of Four Different Treatments

“…hCG and GnRH, alone or combined in various treatment schedules, are the main used hormones [2, 3, 4, 5, 6, 7, 8, 9, 12, 13, 14, 15], but their efficacy remains a debated issue [1, 2, 4]. In fact, great variation in testicular descent has been reported [2, 4], ranging from 0 to 90% [2, 3, 4, 5, 6, 7, 8, 9, 11, 12, 13, 14, 15]. The inclusion of heterogeneous patient populations regarding the type of cryptorchidism (unilateral or bilateral), the site of testicular retention (abdominal or impalpable, inguinal, suprascrotal, high scrotal), and the age at hormonal treatment (from 1st year of life to adolescence) are considered causes of the different clinical results [1, 2, 3, 4, 13].…”

“…Hormonal treatment of cryptorchidism has been used to stimulate the secretion of testicular androgens and to override the imbalance leading to testicular retention [3, 11]. hCG and GnRH, alone or combined in various treatment schedules, are the main used hormones [2, 3, 4, 5, 6, 7, 8, 9, 12, 13, 14, 15], but their efficacy remains a debated issue [1, 2, 4]. In fact, great variation in testicular descent has been reported [2, 4], ranging from 0 to 90% [2, 3, 4, 5, 6, 7, 8, 9, 11, 12, 13, 14, 15].…”

“…Most of the discrepancies appear to be caused by the arbitrary criteria used to consider maldescensus testis and the heterogeneity of patient populations in terms of the initial testis position and the age at treatment [2, 3, 4]. It is also unclear if there are differences with different hormonal trials, because few comparative studies have been performed [2, 4, 8, 9]. …”