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Hormonal therapy in undescended testes.

M Rohatgi¹, D K Gupta, P S Menon

¹Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi.

Indian Journal of Pediatrics

|January 1, 1991

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Human chorionic gonadotropin (HCG) therapy achieved complete testicular descent in 12.5% of prepubertal cryptorchid cases. Response was best for testes in the inguinal canal, with partial descent in impalpable cases.

Area of Science:

Pediatric Endocrinology
Urology
Reproductive Medicine

Background:

Cryptorchidism, the failure of one or both testes to descend into the scrotum, affects a significant number of prepubertal children.
Hormonal therapy, particularly with human chorionic gonadotropin (HCG), is a recognized treatment modality for undescended testes.
Understanding the efficacy of HCG therapy based on gonad location and patient age is crucial for optimizing treatment strategies.

Purpose of the Study:

To evaluate the effectiveness of human chorionic gonadotropin (HCG) therapy in achieving testicular descent in prepubertal boys with cryptorchidism.
To determine if the location of the undescended gonad (inguinal canal, external ring, or impalpable) influences the response to HCG therapy.
To assess the impact of patient age on the success rates of HCG treatment for cryptorchidism.

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Main Methods:

A clinical study involving 78 prepubertal boys with cryptorchidism (40 unilateral, 38 bilateral), encompassing a total of 116 undescended gonads.
Administration of human chorionic gonadotropin (HCG) therapy to the selected participants.
Assessment of complete and partial testicular descent following HCG treatment, with analysis stratified by gonad location and patient age.

Main Results:

Complete testicular descent was observed in 12.5% of all treated gonads (13% unilateral, 12% bilateral).
HCG therapy showed a good response primarily for gonads located within the inguinal canal and at the external ring.
In cases of impalpable testes, no complete descent occurred, but partial descent was noted in 18% of these cases. Older children demonstrated a better response to HCG therapy.

Conclusions:

HCG therapy demonstrates limited efficacy for achieving complete testicular descent in prepubertal cryptorchidism, with success rates around 12.5%.
The anatomical location of the undescended gonad is a critical factor, with inguinal and external ring locations responding better than impalpable testes.
Partial descent in impalpable testes and a better response in older children suggest that HCG therapy may have a role in specific subgroups, warranting further investigation.