Effectiveness of Hormonal and Surgical Therapies for Cryptorchidism: A Systematic Review

Abstract

BACKGROUND AND OBJECTIVE: Controversy remains concerning the optimal treatment approach for cryptorchidism. The objective of this study was to assess effectiveness of hormone therapy or surgery for cryptorchidism. METHODS: We searched Medline and other databases from 1980 to February 2012. Two reviewers independently assessed studies against predetermined criteria. Two reviewers independently extracted data and assigned overall quality and strength of evidence ratings using predetermined criteria. RESULTS: Fourteen studies addressed effectiveness of hormonal treatments, and 26 studies addressed surgical intervention outcomes. Hormonal treatment is associated with testicular descent in some children, but rates generally do not exceed those seen with placebo by >10%. Surgical treatment is associated with success rates of testicular descent ranging from 33% to 100%, depending on surgery. Weighted success averages were 78.7% for 1-stage Fowler-Stephens (FS), 86% for 2-stage FS, and 96.4% for primary orchiopexy. Descent rates were similar among studies comparing laparoscopic and open surgeries. Reported harms of hormonal treatments were mild and transient. Adverse effects specifically associated with surgical repair were rare. CONCLUSIONS: The body of the reviewed literature comprises primarily fair- and poor-quality studies, limiting our ability to draw definitive conclusions. Hormonal treatment is marginally effective relative to placebo but is successful in some children and with minimal harms, suggesting that it may be an appropriate trial of care for some patients. Surgical options are effective, with high rates of testicular descent (moderate strength of evidence for FS procedures, high for primary orchiopexy). Comparable outcomes occur with laparoscopic and open approaches.

European Consensus Statement on congenital hypogonadotropic hypogonadism—pathogenesis, diagnosis and treatment

“…164,165 As such, current recommendations advocate surgical correction at 6-12 months. [166][167][168] Micropenis should be treated early using short-term, low-dose testos terone (dihydrotestosterone or testosterone esters) to induce penile growth (Table 4). 86,169 Importantly, as the duration of treatment is brief, no major concerns regarding virilization or the development of secondary sexual characteristics exist; however, erections might be observed.…”

Canadian Urological Association-Pediatric Urologists of Canada (CUA-PUC) guideline for the diagnosis, management, and followup of cryptorchidism

“…26 Bilateral cases seem to harbour the best response (25-30%). 27 There have been reports suggesting that administration of gonadotropin-releasing hormone (GnRH) either pre or postorchidopexy may improve fertility based on improved fertility indices (ascertained by proxy with the ratio of adult spermatogonia per tubule on testicular biopsies taken at the time of orchidopexy).…”

“…The weighted success rate for primary inguinal orchidopexy was 96.4% based on a systematic review. 26 …”

“…Independently, the overall success rates were 78.7%, 86%, and 96.4% for one-stage FS, two-stage FS, and primary orchiopexy, respectively. 26 …”

“…According to a recent systematic review on this topic, 26 pooled atrophy rates were 1.83% for primary orchidopexy (range 0-4%), 28.1% for one-stage FS (range 22-67%), and 8.2% for two-stage FS (range 0-12%). Similarly, another study has shown that surgical outcomes for IAT were better with a one-stage orchidopexy preserving the testicular vessels as opposed to the one-stage FS technique.…”