F.W.J. Hazebroek

Double-blind, placebo-controlled study of luteinising-hormone-releasing-hormone nasal spray in treatment of undescended testes.

In a double-blind, placebo-controlled study, 252 prepubertal boys with 301 undescended testes were treated with luteinising-hormone-releasing-hormone (LHRH), 1.2 mg/day intranasally. After the 8-week double-blind period 10 placebo-treated (8%) and 14 LHRH-treated (9%) testes had completely descended. After a second LHRH course, involving all the subjects in an open study, 48 testes (18%) had descended completely. The lowest success rate (7%) occurred in the youngest age group (1-2 years). Of the successfully treated testes, 75% could be manipulated at least to the scrotal entrance before treatment. In comparison with age-matched controls, the cryptorchid boys responses to LHRH and human chorionic gonadotropin before treatment did not suggest a deficient hypothalamo-pituitary-gonadal axis or deficient Leydig cell function. After treatment there was no evidence of stimulation of the hypothalamo-pituitary-gonadal axis; serum testosterone did not increase. Surgery was required in 170 patients (196 testes) revealing various anatomical anomalies.

Interdisciplinary structural follow-up of surgical newborns: a prospective evaluation

BACKGROUNDnInformation on physical and developmental outcomes of children with anatomical congenital anomalies (CAs) may indicate the need for early intervention and reduce impact on the childs life and parental burden.nnnMETHODSnFrom 1999 to 2003, 101 children with CA (76.5% of initial survivors) were seen 6-monthly in a tertiary childrens hospital. Growth, neurologic outcome, mental and psychomotor development as determined with the Bayley Scales of Infant Development, and categorization of predictive sociodemographic and medical variables of the children were evaluated prospectively and longitudinally.nnnRESULTSnCongenital diaphragmatic hernia (CDH) and esophageal atresia patients showed impaired growth, that is, both height for age (-1.5 standard deviation score [SDS]) and weight for height (-1.0 SDS). Overall neurologic outcome was normal, however, suspect or abnormal for 40% of CDH patients. Overall mental development was normal, but psychomotor scores were significantly lower than the norm (95% confidence interval, 83.8-92.2 at 6 months and 87.9-98.5 at 24 months). Sex, maternal age, socioeconomic status, CA, severity-of-disease covariables, and need of medical appliances at home could predict negative outcome significantly (P < .05).nnnCONCLUSIONSnThe CA survivors show impaired growth and psychomotor developmental delay up to age 2 years. This warrants specific follow-up programs and infrastructure for these patients.

Fertility potential in a cohort of 65 men with previously acquired undescended testes

PURPOSEnTo evaluate testicular function in men with previously acquired undescended testes (AUDT) in whom spontaneous descent was awaited until puberty followed by orchiopexy in case of nondescent.nnnMETHODSnAndrological evaluation including paternity, scrotal ultrasound, reproductive hormones, and semen analysis was performed in three groups: men with AUDT, healthy controls, and men with previously congenital undescended testes (CUDT).nnnRESULTSnIn comparison with controls, men with AUDT more often had significantly abnormal testicular consistency, smaller testes, lower sperm concentration, and less motile sperm. Except for more often a normal testicular consistency in men with AUDT, no differences were found between men with AUDT and men with CUDT. Also, no differences were found between men with AUDT which had spontaneously descended and men who underwent orchiopexy.nnnCONCLUSIONSnFertility potential in men with AUDT is compromised in comparison with healthy controls, but comparable with men with CUDT. This suggests that congenital and acquired UDT share the same etiology. No significant difference was found between men who had spontaneous descent and men needing orchiopexy. However, fertility potential is unknown for men after immediate surgery at diagnosis, and this should be a subject for future studies.

Surgical findings in acquired undescended testis: An explanation for pubertal descent or non-descent?

AIMnSurgical findings were studied to find an explanation for the phenomenon that some acquired undescended testes (UDT) descend spontaneously whereas others need orchiopexy.nnnMETHODSnIn patients with acquired UDT spontaneous descent was awaited until at least Tanner stage P2G2. Orchiopexy was performed when a stable scrotal position had not been achieved by the end of follow-up.nnnRESULTSnOrchiopexy was needed in 57 of 132 cases (43%). In cases requiring orchiopexy, the difference in testis volume compared to the contralateral healthy testis was significantly larger than for spontaneously descended testes. 41 (72%) undescended testes were found in the superficial inguinal pouch; 16 (28%) at the external annulus. 26 of the 41 testes in the superficial inguinal pouch position (63%) could be manipulated preoperatively into a non-stable scrotal position; 15 could only reach the scrotal entrance prior to surgery. None of the 16 testes located at the external annulus could reach a scrotal position. Inguinal exploration in most cases revealed a fibrous string or a partially open processus vaginalis.nnnCONCLUSIONnThe mobility of acquired UDT located within the external annulus is limited. It is mainly the fibrous string and the partially open processus vaginalis that prevent normal elongation of the spermatic cord with growth. These testes are unlikely to descend spontaneously. Acquired UDT lying in the superficial inguinal pouch can often be pushed down well below the scrotal entrance. We speculate that under normal hormonal stimulation at puberty, some of these growing testes may overcome the strength of the fibrous string in the spermatic cord and descend again spontaneously.