Orchidopexy is generally recommended between six months and one year of age given that many studies have shown that there is a progressive histological deterioration and poorer growth of the undescended testis that is not brought down to the scrotum in early life. Hildorf et al. from Denmark, have retrospectively studied mini-puberty hormones (follicle-stimulating hormone – FSH, luteinizing hormone – LH and inhibin B) and testicular biopsies in 333 boys who underwent orchidopexy (264 unilateral and 69 bilateral procedures) within the first year of life (2010-2019); histologically, they analysed germ cell number and type A dark spermatagonia compared to normal values. Despite early surgery, 25% of boys had a reduced number of germ cells and 21% had low serum inhibin B (both are associated with lower long-term paternity rates). They suggest that some boys may benefit from adjuvant hormonal therapy (luteinising hormone-releasing hormone treatment) to try and improve long-term fertility by increasing the number of germ cells and type A dark spermatagonia per tubule. These results suggest therefore that early orchidopexy may not be the answer for all patients and parents must be aware that early surgery does not guarantee normal fertility. We need to await their longer-term results as this may define the role of adjuvant therapy. Long-term studies must pay attention to paternity rates as perhaps reassuringly, we are already aware that paternity rates in men who have undergone orchidopexy is 89.5% approaching that of the general male population (94%) despite a proportion having a sperm concentration within the World Health Organization (WHO) infertility ranges. It should also be appreciated that biopsies performed during unilateral orchidopexies, do not detect whether there are any anomalies in the contralateral testis – the opposite testis may actually compensate for defects in its counterpart.
Would some boys undergoing orchidopexy benefit from adjuvant hormonal therapy?
Reviewed by Neil Featherstone
Fertility potential is compromised in 20% to 25% of boys with nonsyndromic cryptorchidism despite orchiopexy within the first year of life.
CONTRIBUTOR
Neil Featherstone
Cambridge University Hospitals NHS Foundation Trust (Addenbrookes Hospital).
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