Back to Fall Congress
Effects On Testicular Volume In Cryptorchid Infants Treated With GnRh Pre And Post-Operative Vs Surgery Alone. A Prospective Randomized Trial And Long Term Follow-Up On 62 Cases.
Claudio Spinelli, Professor, Riccardo Pagni, PhD, Lorenzo Fregoli, PhD, Francesco Gori, PhD, Marga Busetto, MD.
University of Pisa, Pisa, Italy.
BACKGROUND:Testicular hypotrophy and subfertility are considered the principal long term consequences of cryptorchidism even after timely orchiopexy. Hormonal treatment for undiscended testes is controversial in literature. The aim of this study is to investigate the effects of Gonadotropin Releasing Hormone analogue (GnRHa, Gondorelin) therapy, performed one month before and one month after surgery. This procedure has been compared with surgery alone, regarding the testicular volume in pediatric age.
METHODS: A total of 62 boys, average age of 2.46 years (range 1-5 years), with 87 undescended intracanalicular testes, never trated surgically or farmacologically, where prospectively assigned to 2 homogeneous groups according to age and testicular volume calculated with ultrasound software (V=0.52 x W x L x H) during a 24 month period. The patients were randomized to recive either orchiopexy alone (31 pts; group A; S) or orchiopexy combined with GnRHa therapy (31 pts; group B; S/HT) as a nasal spray for 4 weeks at 1,2 mg/dl before and 4 weeks after surgery. We used two different surgical approaches in relation to the position of undescended testicle: Shoemaker tecnique for distal tract of the inguinal canal (High Undescended Testis; H-UDT) and Bianchi tecnique for testis close to the external inguinal ring (Low Undescended Testis; L-UDT). All children were evaluated clinically and echographically one month before surgery, at the time of surgery, one month, six months and five years after surgery.
RESULTS: This study has shown that in group B, GnRHa therapy promotes higher testicular volume in long term follow up compared to patients in group A. Volumetric differences recorded during the follow up are reported in table 1. No immediate or delayed postoperative complications occurred in both study groups and the hormonal treatment was well tollerated without any side effects.
CONCLUSIONS: This study has shown statistically significant differences between the testicular volume of the two groups at 5 years follow-up. Also a less invasive procedure as an increase of testicular volume and echogenicity has been observed in the group of patients treated with GnRHa. Therefore hormonal therapy should be recommended in the treatment of cryptorchid testes, expecially in case of hypotrophic testes at the time of diagnosis.
Table 1. Ultrasound mean volumetric measurement in group A and B during follow up.
|Groups||Side||pts||1 month||6 months||5 years|
|Group A||L-UDT||6||0.37 cc||0.33 cc||0.85 cc|
|S - 31 pts||H-UDT||25||0.39 cc||0.28 cc||0,79 cc|
|Group B||L-UDT||7||0.43 cc||0.48 cc||1.40 cc|
|S/HT- 31 pts||H-UDT||24||0.36 cc||0.39 cc||1.38 cc|
Back to Fall Congress