Neoadjuvant Gonadotropin-releasing Hormone Therapy Before Surgery and Effect on Fertility Index in Unilateral Undescended Testes: A Prospective Randomized Trial

Jallouli, Mohamed; Rebaï, Tarek; Abid, Nouha; Bendhaou, Mahdi; Kassis, Mondher; Mhiri, Riadh

doi:10.1016/j.urology.2008.10.078

Cited by 43 publications

(24 citation statements)

References 19 publications

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“…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). [28][29][30] This is a highly controversial topic with conflicting recommendations having been published 28,31 and should therefore be regarded as experimental. There is paucity of data on long-term outcomes of hormone therapy, such as fertility and cancer development.…”

Section: Hormonal Stimulation/hormonal Therapymentioning

confidence: 99%

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

Braga

Lorenzo

Romao

2017

CUAJ

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Section: Hormonal Stimulation/hormonal Therapymentioning

confidence: 99%

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

Braga

Lorenzo

Romao

2017

CUAJ

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“…All males in the untreated group (surgery only) were severely oligospermic, with 20% being azoospermic [20]. Furthermore, neoadjuvant gonadotropin releasing hormone treatment was found to improve the fertility index [20,21]. This profoundly changes our current concept of cryptorchidism treatment.…”

Section: Hormonal Treatment For Descent and Fertilitymentioning

confidence: 99%

Opinion: Comment on Evaluation and Treatment of Cryptorchidism: AUA/AAP and Nordic Consensus Guidelines

Hadžiselimović¹

2016

Urol Int

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The ultimate goal in the treatment of cryptorchidism is to achieve normal fertility. However, in a substantial number of cryptorchid males, early and apparently successful orchidopexy does not improve fertility as it does not address the underlying pathophysiological cause, namely, the impaired transformation of gonocytes into Ad spermatogonia. It is important to realize that over half the patients presenting with unilateral cryptorchidism and the majority of those presenting with bilateral cryptorchidism have abnormal spermiogram which indicates that unilateral cryptorchidism is in fact a bilateral disease and therefore a serious andrological problem. More importantly, only testicular biopsy can nowadays determine which patient should benefit from hormonal therapy. This means that the rationale behind testicular biopsy is both diagnostic and therapeutic, particularly since LH-RHa hormonal therapy is a worthwhile solution to this andrological problem. In boys with a high risk of azoospermia development, adequate treatment with low doses of LH-RHa allowed 86% of subjects to achieve a normal sperm count. This strongly contrasts with the results of the ‘surgery-only' group where not a single patient had a normal spermiogram and 20% suffered from azoospermia. Testicular biopsy is all the more justified that it allowed the detection of in situ carcinoma in 0.6% of all the cryptorchid boys studied. Even if hormonal pre-treatment only achieves successful epididymo-testicular descent in 20% of cases, this treatment should remain the first therapeutic choice because it may avoid resorting to surgery. In addition, it has no adverse effect on fertility and, in unsuccessful cases, facilitates orchidopexy and considerably helps reduce the incidence of post-surgical testicular atrophy, whether unilateral or, and this is a much more serious event, bilateral.

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“…The mean number of spermatogonia per tubule was 1.11 in unilateral and 0.96 in bilateral cases versus 0.47 and 0.56, respectively, in controls. Jallerili et al [ 41 ] prospectively assigned a total of 24 boys, 12-123 months old (median 34.5), with 24 UDT into two groups during a 24-month period. The patients were randomised to receive either orchidopexy alone ( n = 12) or orchidopexy combined with neoadjuvant GnRH therapy ( n = 12) as a nasal spray for 4 weeks at 1.2 mg/day.…”

Section: Adjunctive Therapymentioning

confidence: 99%

Hormonal Treatment

Hutson¹,

Thorup²,

Beasley³

2015

Descent of the Testis

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Neoadjuvant Gonadotropin-releasing Hormone Therapy Before Surgery and Effect on Fertility Index in Unilateral Undescended Testes: A Prospective Randomized Trial

Cited by 43 publications

References 19 publications

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

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

Opinion: Comment on Evaluation and Treatment of Cryptorchidism: AUA/AAP and Nordic Consensus Guidelines

Hormonal Treatment

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