Paternity After Bilateral Cryptorchidism

Lee, Peter A.; O’Leary, Leslie A.; Songer, Nancy J.; Coughlin, Michael T.; Bellinger, Mark F.; LaPorte, Ronald E.

doi:10.1001/archpedi.1997.02170400046008

Cited by 94 publications

(51 citation statements)

References 18 publications

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“…Cryptorchidism is associated with subfertility [19, 20]. Findings to date suggest that a deficiency in the hypothalamic-pituitary axis leads to failure to establish an adequate adult stem cell pool at 2–3 months and defective meiosis at 4–5 years and to reduced germ cell counts in the undescended testes beginning at 7 years of age.…”

Section: Discussionmentioning

confidence: 99%

Abnormal Germ Cell Development in Cryptorchidism

et al. 2001

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Background: Previous studies suggest that two fundamental, probably androgen-dependent, steps in maturation of germ cells normally occur in the prepubertal testis: the disappearance of gonocytes (the fetal stem cell pool) and the appearance of adult dark spermatogonia (the adult stem cell pool) at 2–3 months of age and the appearance of primary spermatocytes (the onset of meiosis) at 4–5 years. Previous studies of small series of cryptorchid boys suggest that both steps are defective in undescended testes and to a lesser degree in descended testes contralateral to unilaterally undescended testes. The purpose of this study is to confirm the previous findings of defective germ cell maturation in a large series of boys with unilateral undescended testes. Patients: Seven hundred and sixty-seven boys with unilateral cryptorchidism who had orchidopexy and bilateral testicular biopsies between birth and 9 years of age were studied. Materials and Methods: Total and differential germ cell counts were performed on semithin histologic sections of the biopsies. The results from the undescended and contralateral descended testes were compared using the Wilcoxon signed-rank test and the Wilcoxon-Whitney-Mann U test. Results: Gonocytes failed to disappear and adult dark spermatogonia failed to appear in undescended testes under 1 year of age indicating a defect in the first step in maturation at 2–3 months resulting in failure to establish an adequate adult stem cell pool. Primary spermatocytes failed to appear in undescended testes and appeared in only 19% of contralateral descended testes at 4–5 years of age indicating a defect in the onset of meiosis. Conclusion: Unilaterally undescended testes fail to establish an adequate adult stem cell pool which normally occurs at 2–3 months of age and fail to establish adequate meiosis which normally occurs at 4–5 years of age. Similar but less severe changes are seen in the contralateral descended testes. Defects in the two pubertal steps in germ cell maturation are associated with reduced total germ cell counts.

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Section: Discussionmentioning

confidence: 99%

Abnormal Germ Cell Development in Cryptorchidism

et al. 2001

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“…The two negative outcomes associated with cryptorchidism are infertility and testicular cancer. Reduced fertility as measured by paternity has been documented in a number of earlier studies [3, 4, 5, 6, 7, 8]. Results of these studies indicated that 13–62% of men with previous bilateral cryptorchidism were able to father at least one child.…”

Section: Introductionmentioning

confidence: 92%

Fertility after Bilateral Cryptorchidism

2001

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Purpose: Evaluation of the fertility of a cohort of formerly bilaterally cryptorchid men in comparison with a group of formerly unilaterally cryptorchid men, and a group of control men. Materials and Methods: Using a detailed questionnaire concerning paternity and factors related to paternity, a cohort of formerly bilateral cryptorchid men were studied and compared with men who had undergone orchiopexy for unilateral cryptorchidism, and a group of control men. All study subjects had had surgery at the Children’s Hospital of Pittsburgh, Pittsburgh, Pa., between 1955 and 1975. A subset of the full cohort underwent clinical evaluation that included a physical examination, serum hormonal determination and semen analyses. Results: Paternity rates are significantly lower among the formerly bilaterally cryptorchid men who have attempted to father a child (65.3%) as compared to the formerly unilaterally cryptorchid (89.7%; p < 0.001) and control men (93.2%; p < 0.001). Differences in the ability to father children are also apparent when semen and hormone levels are compared between the three groups. The bilateral group has significantly lower sperm density and inhibin B levels, and higher FSH and LH levels, than the unilateral and control groups. Conclusions: Men born with bilateral cryptorchidism have severely compromised fertility in adulthood. This reduction in fertility is clearly shown in comparisons of both paternity rates, and in semen and hormone analyses, between the formerly bilateral, formerly unilateral, and control groups.

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“…1,2 Cryptorchidism is associated with impaired fertility, inguinal hernia, and increased risk of testis cancer. [3][4][5] Primary care providers usually diagnose cryptorchidism during routine checkups, at which time the child is referred to a pediatric urologist or surgeon who performs surgical correction (orchiopexy), ideally before the child is 12 months of age. 6,7 The operative approach is based on the palpability of the testis.…”

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confidence: 99%

Diagnostic Performance of Ultrasound in Nonpalpable Cryptorchidism: A Systematic Review and Meta-analysis

2011

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CONTEXT: Ultrasound is frequently obtained during the presurgical evaluation of boys with nonpalpable undescended testes, but its clinical utility is uncertain. OBJECTIVE:To determine the diagnostic performance of ultrasound in localizing nonpalpable testes in pediatric patients. METHODS:English-language articles were identified by searching Medline, Embase, and the Cochrane Library. We included studies of subjects younger than 18 years who had preoperative ultrasound evaluation for nonpalpable testes and whose testis position was determined by surgery. Data on testis location determined by ultrasound and surgery were extracted by 2 independent reviewers, from which ultrasound performance characteristics (true-positives, falsepositives, false-negatives, and true-negatives) were derived. Metaanalysis of 12 studies (591 testes) was performed by using a randomeffects regression model; composite estimates of sensitivity, specificity, and likelihood ratios were calculated. RESULTS:Ultrasound has a sensitivity of 45% (95% confidence interval [CI]: 29 -61) and a specificity of 78% (95% CI: 43-94). The positive and negative likelihood ratios are 1.48 (95% CI: 0.54 -4.03) and 0.79 (95% CI: 0.46 -1.35), respectively. A positive ultrasound result increases and negative ultrasound result decreases the probability that a nonpalpable testis is located within the abdomen from 55% to 64% and 49%, respectively. Significant heterogeneity limited the precision of these estimates, which was attributable to variability in the reporting of selection criteria, ultrasound methodology, and differences in the proportion of intraabdominal testes. CONCLUSIONS:Ultrasound does not reliably localize nonpalpable testes and does not rule out an intraabdominal testis. Eliminating the use of ultrasound will not change management of nonpalpable cryptorchidism but will decrease health care expenditures. Pediatrics

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Paternity After Bilateral Cryptorchidism

Cited by 94 publications

References 18 publications

Abnormal Germ Cell Development in Cryptorchidism

Abnormal Germ Cell Development in Cryptorchidism

Fertility after Bilateral Cryptorchidism

Diagnostic Performance of Ultrasound in Nonpalpable Cryptorchidism: A Systematic Review and Meta-analysis

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