Related Experiment Videos
[The medical treatment of cryptorchism in early childhood]
R Lala1, F Canavese, P Matarazzo
1Divisione di Endocrinologia Pediatrica, Ospedale Infantile Regina Margherita, Torino, Italia.
Insights
Early medical treatment for cryptorchidism using gonadotropin-releasing hormone (GnRH) nasal spray and human chorionic gonadotropin (HCG) achieved testicular descent in nearly half of pediatric patients. This treatment offers a viable option for improving fertility prognosis in children with undescended testes.
Area of Science:
- Pediatric Endocrinology
- Urology
- Reproductive Medicine
Context:
- Cryptorchidism, or undescended testes, affects a significant number of male infants.
- Delayed testicular descent can impact fertility and carries risks of malignancy.
- Current treatment options include hormonal therapy and surgery.
Purpose:
- To evaluate the efficacy of early medical intervention for cryptorchidism.
- To assess the success rates of luteinizing hormone-releasing hormone (LHRH) nasal spray followed by human chorionic gonadotropin (HCG) in achieving testicular descent.
- To determine factors influencing treatment success, such as testicular position and patient age.
Summary:
- A study of 154 children with cryptorchidism investigated treatment with LHRH nasal spray, with HCG administered for failures.
- Overall testicular descent into the scrotum was achieved in 47.3% of cases.
- Treatment success was primarily dependent on the initial position of the testes, with prescrotal testes showing higher response rates than inguinal or abdominal testes.
Impact:
- Medical treatment with LHRH and HCG, initiated after six months of age, can successfully induce testicular descent in approximately half of pediatric patients.
- This approach may improve fertility outcomes by positioning testes within the scrotum.
- The findings support early medical management as a potential alternative or adjunct to surgical intervention for cryptorchidism.
Abstract:
To evaluate the efficacy of early treatment of cryptorchidism, we studied 154 children, 133 with unilateral and 21 bilateral cryptorchidism, between the ages of 6 months and 6 years. Only fullterm newborns without other pathological signs were selected for treatment which was undertaken only after the sixth month of life, when the time of late spontaneous testicular descent has been passed. By clinical evaluation, cryptorchid testes were classified as not palpable, inguinal and prescrotal. Patients were treated by LHRH nasal spray 200 mcg in each nostril 3 times a day (total 1.2 mg/day) for 4 weeks. In the case of failure, HCG (500 I.U. im. 3 times a week for 3 weeks) was further administered. We considered as therapeutic success testicular descent into the lower half of the scrotum. By LHRH treatment 36 testes (20.5%) reached the scrotum, when HCG was added in unsuccessful cases 47 other gonads (26.8%) descended. Total descent rate by LHRH + HCG was 47.3% (table 1). Uni- and bilateral forms of cryptorchidism responded to therapy without any significant difference (table 2). Abdominal testes failed to descend into the scrotum, 28.7% of inguinal testes and 81.3% prescrotal testes descended. Scrotal descent was dependent only by position of cryptorchid testes and not by age of patients (table 3). Higher descent rates obtained at older ages were due to higher incidence of milder forms of cryptorchidism (table 3). Side effects of combined therapy were light. In our experience, medical treatment by LHRH + HCG started after the first 6 months of life causes testicular descent in about one half of testes; it can place into the scrotum gonads with better fertility prognosis.