Sperm Count of Young Men Surgically Treated for Cryptorchidism in the First and Second Year of Life: Fertility is Better in Children Treated at a Younger Age

Abstract

Introduction: Recent data has indicated the usefulness of performing orchiopexy in the first years of life. In this study, we evaluated testicular function in young men operated on for cryptorchidism in the first year of life. To our knowledge, this is the first report on the effects of such an early treatment.

Materials and methods: Testicular function was assessed in a group of young men operated for cryptorchidism during the first year of life (Group A, n=13) and during the second year of life (Group B, n=16).

Results: Total sperm counts were clearly higher in Group A (52.3±14.3 million/ml vs. 30.4±23.5 million/ml, p=0.005) as was sperm motility (36.2±8.7 vs. 23.1±15.7%, p=0.009). A clear inverse relationship was found between age at orchiopexy and total sperm count (r=−0.394, p=0.034) and sperm motility (r=−0.382, p=0.041). The relationship between volume of testes, position at surgery, uni/bilaterality of cryptorchidism, evidence of Ad spermatogonia at biopsy performed during surgery and treatment with LHRH and hCG performed before surgery and fertility was not significant. The latter findings may be partially explained by the low number of patients participating in the study and need further investigation.

Conclusions: We obtained, for the first time, results showing the benefit of treating cryptorchidism during the first year of life rather than in the second year or even later.

Key words

cryptorchidism - orchiopexy - testicular function

References

• 1 Canavese F, Cortese MG, Gennari F. et al . Non palpable testes. Orchipexy in single stage.  Eur J Pediatr Surg. 1995;  5 104-105
• 2 Cortes D, Thorup J, Visfeldt J. Hormonal treatment may harm the germ cells in 1 to 3-year-old boys with cryptorchidism.  J Urol. 2000;  163 1290-1292
• 3 Gapany C, Frey P, Cachat F. et al . Management of cryptorchidism in children: guidelines.  Swiss Med Wkly. 2008;  138 492-498
• 4 Hadžiselimović F. Cryptorchidism. Ultrastructure of normal and cryptorchid testis development.  Adv Anat Embryo Cell Biol. 1977;  53 3
• 5 Hadžiselimović F, Herzog B. The importance of both an early orchidopexy and germ cell maturation for fertility.  Lancet. 2001;  358 1156-1157
• 6 Hadžiselimović F, Emmons LR, Buser M. A diminished postnatal surge of Ad spermatogonia in cryptorchid infants is additional evidence for hypogonadotropic hypogonadism.  Swiss Med Wkly. 2004;  134 381-384
• 7 Hadžiselimović F, Hocht B, Heerzog B. et al . Infertility in cryptorchidism is linked to the stage of germ cell development at orchidopexy.  Horm Research. 2007;  68 46-52
• 8 Hadžiselimović F. Successful treatment of unilateral cryptorchid boys risking infertility with LH-RH analogue.  Int Braz J Urol. 2008;  34 319-326
• 9 Hedinger C. Histopathology of the cryptorchid testes. In: Bierich JR, Giarola A, eds. Proceedings of the Serono Symposia. 1979 25: 29-39
• 10 Huff DS, Fenig DM, Canning DA. et al . Abnormal germ cell development in cryptorchidism.  Horm Research. 2001;  55 11-17
• 11 Lala R, de Sanctis C, Canavese F. et al . Early medical and surgical treatment of cryptorchidism: clinical, anatomic and histological findings.  Pediatr Surg Intern. 1992;  7 368-371
• 12 Lala R, Matarazzo P, Chiabotto P. et al . Early hormonal and surgical treatment of cryptorchidism.  J Urol. 1997;  157 1898-1901
• 13 Lala R, Canavese F, Andreo R. et al . Testicular function of young men treated in childhood for cryptorchidism.  Horm Research. 2001;  55 53
• 14 Mengel W, Hienz HA, Sippell WG. et al . Studies on cryptorchidism: A comparison of histological findings in the germinative epithelium before and after the second year of life.  J Pediatr Surg. 1974;  9 445-450
• 15 Mizuno K, Hayashi Y, Kojima Y. et al . Early orchiopexy improves subsequent testicular development and spermatogenesis in the experimental cryptorchid rat model.  J Urol. 2008;  179 1195-1199
• 16 Murphy F, Paran TS, Puri P. Orchidopexy and its impact on fertility.  Pediatr Surg Int. 2007;  23 625-632
• 17 Ritzén EM, Bergh A, Bjerknes R. et al . Nordic consensus on treatment of undescended testes.  Acta Paediatr. 2007;  96 638-643
• 18 Swerdlow AJ, Higgins CD, Pike MC. Risk of testicular cancer in cohort of boys with cryptorchidism.  BMJ. 1997;  314 1507-1511
• 19 Trsinar B, Muravec UR. Fertility potential after unilateral and bilateral orchidopexy for cryptorchidism.  World J Urol. 2009;  [In press, DOI 10.1007/s00345-009-0406-0] 
• 20 Vilar O. Histology of the human testis from neonatal to adolescence. In: Rosenberg E, Paulsen CA, eds. The human Testis. New York: Plenum Press 1970: 95
• 21 World Health Organisation .WHO laboratory manual for the examination of human semen and sperm-cervical mucus interaction 4th ed. Cambridge: Cambridge University Press 1999

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