#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Cryptorchidism - what is the best timing and method of treatment?


Authors: R. Kočvara
Authors‘ workplace: 1. LF UK a VFN, Praha ;  Urologická klinika
Published in: Urol List 2007; 5(1): 30-33

Overview

Cryptorchidism covers (most often) retained, ectopic, missing and subsequently undescended testicle. In their first year of age, about 1% of boys still have a testicle undescended in the scrotum. The diagnosis requires physical bimanual examination - retracted testicle is best distinguished when patient is sitting cross-legged. Treatment of cryptorchidism may start as early as six months of age and the testicle should descend in scrotum by 1.5 years of age. When testicle is palpable, the golden standard treatment is orchidopexy, using, as a rule, the inguinal approach. For unpalpable testicle diagnostic laparoscopy is usually indicated: for intra-abdominal testicle a in one or two stages orchidopexy is performed (using laparoscopy or open approach). Unclear findings with revision of inguinal canal and dead ending internal spermatic vessels indicate anorchia. Distinctively hypoplastic testicle is indicated for orchidectomy. Hormonal treatment by HCG or LHRH analogue tends to lead to testicle descending only in low levels of retention. Recent trend has been neo- adjuvant or adjuvant hormonal treatment for operation which should improve future fertility.

Key words:
cryptorchidism, testicle retention, laparoscopy, orchidopexy, hormonal treatment


Sources

1. Atwell JD. Ascent of the testis: fact or fiction. Br J Urol 1985; 57: 474-475.

2. Baker LA, Silver RI, Docimo SG. Cryptorchidism. In: Rink G (ed). Pediatric Urology. Philadelphia: WB Saunders Company 2001: 738-753.

3. Cortes D, Thorup J, Visfeld J. Hormonal treatment may harm germ cells in 1-3 year old boys with cryptorchidism. J Urol 2000; 163: 1290.

4. Fowler R, Stephens FO. The role of testicular vascular anatomy in the salvage of high undescended testes. Aus N Z J Surg 1959; 29: 92.

5. Gibbons MD, Cromie WJ, Duckett JW. Management of the abdominal undescended testicle. J Urol 1979; 122: 76-79.

6. Hadžiselimovič F. Cryptorchidism. Management and Implications. New York: Springer Verlag 1983: 135.

7. Hadziselimovic JF et al. The importance of mini-puberty for fertility in cryptorchidism. J Urol 2005; 174: 1536-1539.

8. Hadziselimovic F, Herzog B. Treatment with luteinizing hormone releasing hormone analogue after successful orchidopexy markedly improves the chance of fertility later in life. J Urol 1997; 158(Suppl 342): 1193-1195.

9. Hadziselimovic F, Herzog B. The importance of both an early orchidopexy and germ cell maturation for fertility. Lancet 2001; 358: 1156-1157.

10. Heiskanen P, Billig J, Toppari J et al. Apoptotic cell. Death in the norma and cryptorchid human testis: the effect of human chorionic gonadotropin on testicular cell survival. Ped Res 1996; 40: 351-356.

11. Huff DS, Snyder HM, Rusnack SL et al. Hormonal therapy for the subfertility of cryptorchidism. Horm Res 2001; 55: 38-40.

12. Husmann DA. Cryptorchidism. In: Belman K et al (eds). Clinical Pediatric Urology. 4. vyd. London: Martin Dunith Ltd 2002: 1125-1154.

13. Jordan GH, Winslow BH. Laparoscopic single stage and staged orchiopexy. J Urol 1994; 152: 1249-1252.

14. Kočvara R. Kryptorchizmus in Urologie.1.vyd. Praha: ISV nakladatelství 1994; 1. vol: 1269-1280.

15. Kogan S, Hadžiselimovič F, Snyder HM et al. Pediatric Andrology. In: Gillenwater JY et al (eds). Adult and Pediatric Urology. 3. ed. New York: Mosby 1996: 2623-2674.

16. Lala R, Matarazzo P, Chiabotto P et al. Combined therapy with LHRH and HCG in cryptorchid infants. Eur J Pediatr 1993; 152(suppl 2): S31-S33.

17. Lisá L. Nesestouplá varlata. Ces Pediat 1996; 51: 235-237.

18. Pyörälä S, Huttunen NP, Uhari M. A review and meta-analysis of hormonal treatment of cryptorchidism. J Clin Endocrinol Metab 1995; 80: 2795-2799.

19. Riedmiller H, Androulakakis P, Beurton D et al. EAU Guidelines on Paediatric Urology. Eur Urol 2001; 40: 589-599.

20. Schwentner C, Oswald J, Kreczy A et al. Neo­adjuvant gonadotropin-releasing hormone therapy before surgery may improve the fertility index in undescended testes: a prospective randomized trial. J Urol 2005; 173: 974-977.

21. Svitač J, Kliment J. Nehmatné testis diagnostika a liečba. Rozhl Chir 1992; 71: 688-692.

Labels
Paediatric urologist Urology
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#