re; Undescended testis
I read with interest the paper by Drs Nah and colleagues on; Undescended testis;513 patients' characteristics, age at orchidopexy and patterns of referral (1). The objective of this study was to describe current practice at the time of orchidopexy . The results obtained should help to identify the corrections necessary to optimize the treatment Several principal questions should be raised: 1. The greatest challenge in a discussion regarding undescended testicles is to exclude the retractile testis, for which no treatment would be required except categorical reassurance. Examination in older boys has certainly fooled many doctors and even experienced surgeons many times. Over half of the patients sent for treatment could be expected to meet the criteria for retractile testis and ff such cases are "treated", of course, the "results" would be good. Therefore, it is vital to exclude such cases from the discussion. The comparison of histology and hormonal levels exemplify hypogonadotropic hypogonadism in the majority of cryptorchid boys.(2) Importantly, only histological examination of the testicular biopsy can distinguish a true cryptorchid testis from retractile one. Therefore, to conclude that only congenital cryptorchid testes were treated because these boys had surgery is inappropriate.
2. Most importantly, an early and seemingly successful orchidopexy does not improve fertility in a substantial number of cryptorchid males because it does not address the underlying pathophysiology of cryptorchidism, namely, the impaired transformation of gonocytes into Ad spermatogonia (impaired mini-puberty). It has been demonstrated that all males having had an early (timely) and successful surgery but belonging to the high infertility risk group develop severe oligospermia, with 20% being azoospermic.(3) Furthermore, it has been demonstrated that infertility caused by cryptorchidism, which is believed to be a congenital malformation, can be successfully corrected if adequately treated. (4) In conclusion, the recommendation to perform orchidopexy at an early age gives the wrong impression that performing orchidopexy at an early age will prevent development of infertility.
1 . Nah SA, Yeo CH, How G et al. Undescended testis: 513 patients' characteristics, age at orchidopexy and patterns of referral Arch. Dis. Child. 2013 0:Archdischild-2013-305225v1-archdischild-2013-305225; doi:10.1136/archdischild-2013-305225
2. Hadziselimovic F, Hoecht B: Testicular histology related to fertility outcome and postpubertal hormone status in cryptorchidism. Klin P?diatr (2008) 220: 302-307
3. Hadziselimovic F, Hadziselimovic NO, Demougin P, et al. Testicular gene expression in cryptorchid boys at risk of azoospermia. (2011).Sex Dev 5: 49-59 . 4. Hadziselimovic F: Successful treatment of unilateral cryptorchid boys risking infertility with LH-RH analogue. Int Braz J Urol (2008).34: 319- 326
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