Surgical and Hormonal Therapy for Cryptorchidism: An Overview

Abstract

The treatment of the undescended testis still engenders controversy on both sides of the Atlantic. To date, there is still no consensus on how to treat a child with an undescended testis. Some physicians advocate surgical therapy of all children whose testes are not located at the bottom of the scrotum whereas others feel that hormonal therapy should be tried initially on all such boys. The following attempts to provide an objective assessment of each of these two therapeutic modalities, highlighting the current controversies.

Surgical treatment of undescended testes

“…The diagnosis of a true undescended testis relies mainly on the hands of an experienced examiner. In specific cases, if there is doubt about the diagnosis of low undescended testis versus retractile testis, hormonal medical application may be helpful in older boys and proposed by some authors (13). Multiple studies have shown that the experienced examiner has a higher sensitivity in locating an undescended testis than ultrasonography, computed tomography or magnetic resonance imaging (14).…”

Management of the non‐descended testis: doubtful value of luteinizing‐hormone‐releasing‐hormone (LHRH). A double‐blind, placebo‐controlled multicentre study

“…We did not exclude boys with retractile testis, as this condition is often misdiagnosed. Some workers argue that these testes have a high response rate to treatment with LHRH and their varying inclusion may have influenced the results in studies with high response rates (Rajfer, 1988). Moreover, treatment with LHRH could differentiate between boys with true non-descent and boys with retractile testes.…”

“…Part of this huge variation may be explained by poor definition of the term 'non-descended testis', observer variation and difficulties in the clinical diagnosis Correspondence: Dr L. H. Olsen, Department of Surgery K, Odense University Hospital, DK-5000 Odense C., Denmark. (Olsen, 1989), the varying inclusion of bilateral and unilateral cases (Christiansen et al, 1988), differences in age distribution, the varying inclusion of retractile testis (Rajfer, 1988) and differences in the initial position of the testes. Finally, the minority of the studies published until now have been conducted as randomized controlled trials.…”

Artificial Intra-Abdominal Cryptorchidism in Young Adult Rats Leads to Irreversible Azoospermia

“…Treatment of cryptorchidism is done either hormon ally [20,21], or surgically by orchiopexy [6,17,21], the question remaining, however, of whether such testicles eventually contribute to fertility [1,5].…”