Skip to main content

Advertisement

SpringerLink
Log in

The controversy regarding the need for hormonal treatment in boys with unilateral cryptorchidism goes on: a review of the literature

  • Review
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Hormonal treatment for unilateral undescended testes continues to be recommended in some countries. We reviewed the literature in favor and against this recommendation. Since the paternity rate of men with a history of unilateral undescended testes only treated with surgery is normal, the effectiveness of hormonal treatment to produce testicular descent is low, the cost is considerable, and there are potential adverse effects, hormonal treatment for boys with unilateral undescended testes should no longer be recommended.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Atkinson PM (1975) A follow-up study of surgically treated cryptorchid patients. J Pediatr Surg 10:115–119

    Article  PubMed  CAS  Google Scholar 

  2. Barthold JS (2008) Undescended testis: current theories of etiology. Curr Opin Urol 18(4):395–400

    Article  PubMed  Google Scholar 

  3. Barthold JS, Manson J, Regan V, Si X, Hassink SG, Coughlin MT, Lee PA (2004) Reproductive hormone levels in infants with cryptorchidism during postnatal activation of the pituitary-testicular axis. J Urol 172:1736–1741

    Article  PubMed  CAS  Google Scholar 

  4. Biers SM, Malone PS (2010) A critical appraisal of the evidence for improved fertility indices in undescended testes after gonadotrophin-releasing hormone therapy and orchidopexy. J Pediatr Urol 6:239–246

    Article  PubMed  CAS  Google Scholar 

  5. Borgward TG (2004) Bernhard Schapiro (1888-1966): Talmudic scholar-andrologist-pioneer of hormonal Treatment for cryptorchidism. Wurzbg Medizinhist Mitt 23:393–411

    Google Scholar 

  6. Callaghan P (2000) Undescended testis. Pediatr Rev 21:395

    PubMed  CAS  Google Scholar 

  7. CendronM KMA, Huff DS, Koop CE, Snyder HM 3rd, Duckett JW (1989) Cryptorchidism, orchiopexy and infertility: a critical long-term retrospective analysis. J Urol 142:559–562

    Google Scholar 

  8. Cooper TG, Noonan E, von Eckardstein S, Auger J, Baker HW, Behre HM, Haugen TB, Kruger T, Wang C, Mbizvo MT, Vogelsong KM (2010) World Health Organization reference values for human semen characteristics. Hum Reprod Update 16:231–245

    Article  PubMed  Google Scholar 

  9. Cortes D, Thorup J, Lindenberg S, Visfeldt J (2003) Infertility despite surgery for cryptorchidism in childhood can be classified by patients with normal or elevated follicle-stimulating hormone and identified at orchidopexy. BJU Int 91:670–674

    Article  PubMed  CAS  Google Scholar 

  10. Cortes D, Thorup J, Visfeldt J (2000) Hormonal treatment may harm the germ cells in 1 to 3-year-old boys with cryptorchidism. J Urol 163:1290–1292

    Article  PubMed  CAS  Google Scholar 

  11. Cortes D, Thorup JM, Visfeldt J (2001) Cryptorchidism: aspects of fertility and neoplasms. A study including data of 1335 consecutive boys who underwent testicular biopsy simultaneously with surgery for cryptorchidism. Horm Res 55:21–27

    Article  PubMed  CAS  Google Scholar 

  12. De Muinck Keizer-Schrama SM, Hazebroek FW, Drop SL, Degenhart HJ, Molenaar JC, Visser HK (1988) Hormonal evaluation of boys born with undescended testes during their first year of life. J Clin Endocrinol Metab 66:159–164

    Article  PubMed  Google Scholar 

  13. Demirbilek S, Atayurt HF, Celik N, Aydin G (1997) Does treatment with human chorionic gonadotropin induce reversible changes in undescended testes in boys? Pediatr Surg Int 12:591–594

    Article  PubMed  CAS  Google Scholar 

  14. Dunkel L, Taskinen S, Hovatta O, Tilly JL, Wikström S (1997) Germ cell apoptosis after treatment of cryptorchidism with human chorionic gonadotropin is associated with impaired reproductive function in the adult. J Clin Invest 100:2341–2346

    Article  PubMed  CAS  Google Scholar 

  15. Fallon B, Kennedy TJ (1985) Long-term follow-up of fertility in cryptorchid patients. Urology 25:502–504

    Article  PubMed  CAS  Google Scholar 

  16. Fanconi S, Reinberg O, Gapany G, Meyrat BJ, Frey F, Vaudaux B, Di Bernardo S, Boulos T, Sekarski S, Spehrs-Ciaffi V, Jeannet PY (2008) Pediatrics. Rev Med Suisse 4:61–66

    PubMed  CAS  Google Scholar 

  17. Forest MG, Sizonenko PC, Cathiard AM, Bertrand J (1974) Hypophyso-gonadal function in humans during the first year of life. 1. Evidence for testicular activity in early infancy. J Clin Invest 53:819–828

    Article  PubMed  CAS  Google Scholar 

  18. Hadziselimovic F, Emmons LR, Buser MW (2004) A diminished postnatal surge of Ad spermatogonia in cryptorchid infants is additional evidence for hypogonadotropic hypogonadism. Swiss Med Wkly 134:381–384

    PubMed  Google Scholar 

  19. Hadziselimovic F, Herzog B (2001) Importance of early postnatal germ cell maturation for fertility of cryptorchid males. Horm Res 55:6–10

    Article  PubMed  CAS  Google Scholar 

  20. Hadziselimovic F, Hocht B, Herzog B, Buser MW (2007) Infertility in cryptorchidism is linked to the stage of germ cell development at orchidopexy. Horm Res 68:46–52

    Article  PubMed  CAS  Google Scholar 

  21. Jallouli M, Rebai T, Abid N, Bendhaou M, Kassis M, Mhiri R (2009) Neoadjuvant gonadotropin-releasing hormone therapy before surgery and effect on fertility index in unilateral undescended testes: a prospective randomized trial. Urology 73:1251–1254

    Article  PubMed  Google Scholar 

  22. Job JC, Toublanc JE, Chaussain JL, Gendrel D, Roger M, Canlorbe P (1987) The pituitary-gonadal axis in cryptorchid infants and children. Eur J Pediatr 146:S2–S5

    Article  PubMed  Google Scholar 

  23. Kollin C, Karpe B, Hesser U, Granholm T, Ritzén EM (2007) Surgical treatment of unilaterally undescended testes: testicular growth after randomization to orchiopexy at age 9 months or 3 years. J Urol 178:1589–1593

    Article  PubMed  Google Scholar 

  24. Lala R, Matarazzo P, Chiabotto P, de Sanctis C, Canavese F, Hadziselimovic F (1993) Combined therapy with Lhrh and Hcg in cryptorchid infants. Eur J Pediatr 152:S31–S33

    Article  PubMed  Google Scholar 

  25. Lee PA, O'Leary LA, Songer NJ, Coughlin MT, Bellinger MF, LaPorte RE (1996) Paternity after unilateral cryptorchidism: a controlled study. Pediatrics 98:676–679

    PubMed  CAS  Google Scholar 

  26. Lee PA, Coughlin MT (2002) The single testis: paternity after presentation as unilateral cryptorchidism. J Urol 168:1680–1682

    Article  PubMed  Google Scholar 

  27. Lee PA, Coughlin MT, Bellinger MF (2000) Paternity and hormone levels after unilateral cryptorchidism: association with pretreatment testicular location. J Urol 164:1697–1701

    Article  PubMed  CAS  Google Scholar 

  28. Marchetti F, Bua J, Tornese G, Piras G, Toffol G, Ronfani L, Italian Study Group on Undescended Testes ISGUT (2012) Management of cryptorchidism: a survey of clinical practice in Italy. BMC Pediatr 12(1):4

    Article  PubMed  Google Scholar 

  29. Mathers MJ, Sperling H, Rübben H, Roth S (2009) Hodenhochstand: diagnostik, therapie und langfristige konsequenzen. Dtsch Arztebl Int 106:527–532

    PubMed  Google Scholar 

  30. Miller KD, Coughlin MT, Lee PA (2001) Fertility after unilateral cryptorchidism. Paternity, time to conception, pretreatment testicular location and size, hormone and sperm parameters. Horm Res 55:249–253

    Article  PubMed  CAS  Google Scholar 

  31. Niederberger C, Joyce GF, Wise M, Meacham RB (2007) Male infertility. In: MS Litwin, CS Saigal (eds) Urologic diseases in America. US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. US Government Printing Office, Washington, DC, NIH Publication No. 07-5512, 2007, pp 461-481

  32. Paasch U, Thieme C, Grunewald S, Glander HJ (2004) Electronic data base systems support the evaluation of male infertility factors, example cryptorchidism. Urol Int 72:154–161

    Article  PubMed  CAS  Google Scholar 

  33. Pettersson A, Richiardi L, Nordenskjold A, Kaijser M, Akre O (2007) Age at surgery for undescended testis and risk of testicular cancer. N Engl J Med 356:1835–1841

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  35. Raivio T, Toppar J, Kaleva M, Virtanen H, Haavisto AM, Dunke L, Jänne OA (2003) Serum androgen bioactivity in cryptorchid and noncryptorchid boys during the postnatal reproductive hormone surge. J Clin Endocrinol Metab 88:2597–2599

    Article  PubMed  CAS  Google Scholar 

  36. Retief PJ (1977) Fertility in undescended testes. S Afr Med J 52:610–613

    PubMed  CAS  Google Scholar 

  37. Ritzén EM, Bergh A, Bjerknes R, Christiansen P, Cortes D, Haugen SE, Jörgensen N, Kollin C, Lindah lS, Lackgren G, Main KM, Nordenskjöld A, Rajpert-De Meyts E, Söder O, Taskinen S, Thorsson A, Thorup J, Toppari J, Virtanen H (2007) Nordic consensus on treatment of undescended testes. Acta Paediatr 96:638–643

    Article  PubMed  Google Scholar 

  38. Schwentner C, Oswald J, Kreczy A, Lunacek A, Bartsch B, Deibl M, Radmayr C (2005) Neoadjuvant gonadotropin-releasing hormone therapy before surgery may improve the fertility index in undescended testes: a prospective randomized trial. J Urol 173:974–977

    Article  PubMed  CAS  Google Scholar 

  39. Suomi AM, Main KM, Kaleva M, Schmidt IM, Chellakooty M, Virtanen HE, Boisen KA, Damgaard IN, Kai CM, Skakkebaek NE, Toppari J (2006) Hormonal changes in 3-month-old cryptorchid boys. J Clin Endocrinol Metab 91:953–958

    Article  PubMed  CAS  Google Scholar 

  40. Thorsson AV, Christiansen P, Ritzén M (2007) Efficacy and safety of hormonal treatment of cryptorchidism: current state of the art. Acta Paediatr 96:628–630

    Article  PubMed  Google Scholar 

  41. Virtanen HE, Toppari J (2008) Epidemiology and pathogenesis of cryptorchidism. Hum Reprod Updat 14:49–58

    Article  CAS  Google Scholar 

Download references

Conflict of interest

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Kinderchirurgie und Kinderurologie, Kinderkrankenhaus auf der Bult, Janusz-Korszak-Allee 12, Hannover, Germany

    Barbara Ludwikowski & Ricardo González

  2. Kinderurologie, Kinderspital Univesität Zürich, Steinwiesstrasse 75, 8032, Zürich, Switzerland

    Ricardo González

  3. Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA

    Ricardo González

Authors
  1. Barbara Ludwikowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ricardo González
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ricardo González.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ludwikowski, B., González, R. The controversy regarding the need for hormonal treatment in boys with unilateral cryptorchidism goes on: a review of the literature. Eur J Pediatr 172, 5–8 (2013). https://doi.org/10.1007/s00431-012-1711-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-012-1711-y

Keywords

Search

Navigation