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Response to: The Majority of Boys Having Orchidopexy for Congenital Nonsyndromic Cryptorchidism during Minipuberty Exhibited Normal Reproductive Hormonal Profiles
The title of our paper “The Majority of Boys Having Orchidopexy for Congenital Nonsyndromic Cryptorchidism during Minipuberty Exhibited Normal Reproductive Hormonal Profiles” refers to the findings in our study and is not a universal statement regarding hormonal profiles in boys with cryptorchidism in minipuberty. However, as far as we are aware, our study is the first to present histological and hormonal data from boys being operated in the minipuberty. We clearly state that our series is highly selected. The fact that all are full-term babies with normal birthweight, only 14% are bilateral cases, and 55% of the testes were placed in the inguinal canal or above indicates the selection compared with cryptorchidism in general. As stated by Verkauskas et al (reference 3 of the letter to the editor), the estimated incidence of abrogated minipuberty has been reported to be as high as 50% among boys with cryptorchidism. We do not disagree with this statement. But there is another 50% of boys with cryptorchidism (e.g., undescended testes can be a part of a caudal field defect). All the patients in the latter study by Verkauskas et al (reference 3 of the letter to the editor) were operated after minipuberty with a median age of 15 months. In their study, the serum level of luteinizing hormone was significantly lower in the group with no Ad spermatogonia than in the group with Ad spermatogonia. They concluded that the group with no Ad spermatogonia lacked transformation of gonocytes into Ad spermatogonia. So, in this group of boys with cryptorchidism operated after minipuberty, the abrogated minipuberty was the cause of the lack of Ad spermatogonia. All 23% of patients in our selected group operated in minipuberty with impaired number of Ad spermatogonia had normal serum level of luteinizing hormone and half of them had even luteinizing hormone above the normal 97.5 percentile. This indicates a strong and competent gonadotropin feedback mechanism responding to a primary congenital gonadal impairment of germ cell status. Within the whole spectrum of cryptorchidism, the group with congenital impairment of germ cell status and competent genuine gonadotropin stimulation is probably smaller than the group with abrogated minipuberty and ongoing gonadotropin insufficiency. It is just our hypothesis that such boys with cryptorchidism will benefit extra from early surgery already in minipuberty. However, more data and follow-up are needed.
Simone Hildorf, Dina Cortes, and Jorgen Thorup
Article published online:
09 March 2022
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