Prospective evaluation of human chorionic gonadotropin in the treatment of cryptorchidism

Of 158 boys consecutively referred for undescended testis, 77 were found to have true cryptorchidism. Human chorionic gonadotropin (HCG) was given to 60 boys (63 undescended testes) in a dose of 5,000 U (patient age 4-6 years) or 10,000 U (7-9 years). The parents of seven others preferred direct referral for orchiopexy. Minor side effects occurred in 18 boys. Significant increase in weight increment velocity was seen among 7-9-year-olds. Descent of testis occurred in 59% (95% cl 46-71%), with the incidence significantly higher in the older group. Mobile testes were more likely to descend. At surgery following failed HCG treatment, hernia or hydrocele was unexpectedly found in 77% of cases, and 19% of the testes were ectopic in the superficial inguinal pouch. The risk of repeat orchiopexy was not less than in a previous series of primary orchiopexy. Although surgery could be avoided in approximately half of the patients in this series, it is not yet decisively established if HCG should be used diagnostically or therapeutically. Improved pre-treatment identification of ectopia and hernia is required.