Summary
Introduction/Background
Currently the standard treatment for bilateral cryptorchidism is bilateral surgical
orchidopexy. Whether a hormonal treatment should be routinely administered postoperatively
to increase fertility is debatable. Low-dose postoperative luteinizing hormone releasing
hormone (LHRH) can increase spermatogonial numbers, but the effect of native LHRH
(Kryptocur®) on adult fertility is unclear.
Objective
To determine if low-dose every-second-day postoperative LHRH administration in children
with bilateral cryptorchidism improves fertility in adulthood and if Nistal testicular
histological grading could guide the decision to administer LHRH.
Study design Methods
All patients, actually at least 16yr of age, that underwent a bilateral orchidolysis
and orchidopexy for bilateral cryptorchidism (surgery between 1997 and 2018) were
contacted and offered a clinical exam, hormone levels, sperm analysis, and a scrotal
ultrasound. At the original surgery, testicular biopsy was performed (if 60% of the
tubuli contain >1 spermatogonia, this is normal = Nistal-1, if 30–60% filled = Nistal-2,
if <30% = Nistal-3 and if Sertoli only = Nistal-4) and if in at least one testis impaired.
A low dose native LHRH treatment was offered to the patients, as this treatment is
known to increase the number of spermatogonia in a short term. Kryptocur® (LHRH, Gonadorelin,
Hoechst®) was prescribed and dosed at 200 μg (one spray in one nostril) every other
day for 6–8 months.
Results and limitations
Forty-two men were eligible for this study. 20/42 accepted the invitation for a clinical
and hormonal evaluation. 16/20 men accepted the invitation for an additional sperm
analysis. Fourteen of 20 men received low-dose LHRH postoperatively in a nonrandomized
manner. Three men had Nistal grade 1, eight grade 2, seven grade 3, and two had grade
4. Inhibin B levels were higher in men with Nistal 1 and 2 compared with Nistal 3
and 4 P ≤ 0.037). Severe oligospermia/azoospermia (<1 × 106/ejaculate) was observed in 33% of the treated group vs 67% of the untreated group
(P ≤ 0.036.)
Discussion and conclusions
Graphical AbstractAdministration of a postoperative low-dose every-second-day LHRH (Kryptokur®) treatment
in boys with bilateral undescended testes can rescue their fertility potential to
a considerable degree and reduce the development of azoospermia. The main study limitations
are the non-random administration of LHRH and heterogeneity among LHRH regimens.
Keywords
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Article info
Publication history
Published online: October 13, 2022
Accepted:
October 11,
2022
Received in revised form:
September 14,
2022
Received:
May 11,
2022
Identification
Copyright
© 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
