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[Drug treatment of cryptorchidism]
1Clinica Pediatrica I, Università degli Studi di Bologna, Italia.
Insights
The best treatment for undescended testes (cryptorchidism) remains debated. While human chorionic gonadotropin (HCG) can be effective, surgery is often necessary for intra-abdominal testes, with timing dependent on medical treatment response.
Area of Science:
- Pediatric Urology
- Endocrinology
Context:
- Management of undescended testes (cryptorchidism) involves ongoing debate regarding optimal medical versus surgical approaches.
- Human chorionic gonadotropin (HCG) has been a traditional medical treatment, with varying success rates depending on testis location and patient age.
- Intranasal gonadotropin-releasing hormone (GnRH) analogues are less established and appear less potent than HCG.
Purpose:
- To evaluate the efficacy of medical (HCG, LHRH) and surgical management for cryptorchidism.
- To provide guidance on the timing and approach for treating undescended testes, considering treatment response and gonad location.
Summary:
- Complete testicular descent occurs in 14-59% of cases treated with HCG, with better outcomes in older children and less success for intra-abdominal testes.
- Surgical intervention (orchiopexy) is increasingly recommended at earlier ages.
- Our expert opinion suggests orchiopexy around age 2 if medical treatment fails for intra-abdominal or high inguinal testes; a second HCG course may be considered for partially responsive testes near the scrotum around age 4.
Impact:
- Informs clinical decision-making for pediatric urologists and endocrinologists managing cryptorchidism.
- Highlights the importance of individualized treatment strategies based on testis location, age, and response to therapy.
- Aims to optimize outcomes and prevent long-term complications associated with undescended testes.
Abstract:
There is still a debate on the choice of medical or surgical approach for the management of the undescended testis and on their efficacy in preventing long-term complications. HCG has long been used, with various schedules, in the treatment of cryptorchidism. A complete descent occurs in 14-59% of cases, with the highest percentages in older children and the lowest in intra-abdominal testes. The usefulness of intranasally administered LHRH is even more controversial and its potency seems inferior to HCG. In the last decades the surgical intervention has been recommended at progressively earlier ages. Our opinion is that the orchiopexy is inevitable, around age 2 years, if medical treatment has failed and the gonad is located intra-abdominally or high in the inguinal canal. In contrast, if the testis shows a partial response to medical treatment and is close to the scrotum, a second HCG course can be performed around age 4 years.