The influence of patency of the vaginal process on the efficacy of hormonal treatment of cryptorchidism.
To investigate the effects of patency of the vaginal process (processus vaginalis testis) on the efficacy of hormonal treatment of cryptorchidism, we carried out a blind, controlled, prospective study in which all patients underwent inguinal herniography. The sample comprised 310 boys with true cryptorchidism (244 unilateral, 66 bilateral) and without symptomatic hernia/ hydrocele or other pathologies. Patients age ranged from 8 months to 11 years 5 months. All patients were treated with human chorionic gonadotropin (twice-weekly intramuscular injections for 5 weeks; total dose 2500 IU for patients less than 1-year-old, 5000 IU for 1- to 6-year-olds, 10000 IU for 6- to 11-year-olds). Following treatment, 37% (139/376) of the testes descended. The incidence of descent was highest for testes initially in caudal positions. Considering only non patent (i.e., normal) vaginal processes, the incidence of testis descent was 49.5% (139/281); none of the 95 testes associated with a patent vaginal process descended in response to hormone treatment.


CONCLUSIONS
Prior detection of patent vaginal process by inguinal herniography permits identification of a significant subset of patients for whom hormone treatment will be ineffective. Our data suggest that this predictive procedure is 100% reliable.
Varela Cives
R
R
Complejo Hospitalario Universitario, de Santiago, Spain.
Bautista Casasnovas
A
A
Alonso Martin
A
A
Pombo Arias
M
M
Tojo Sierra
R
R
D002648:Child; D002675:Child, Preschool; D006063:Chorionic Gonadotropin / Q000627:therapeutic use*; D003456:Cryptorchidism / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006552:Hernia, Inguinal / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D011859:Radiography; D013737:Testis / Q000002:abnormalities*
D006063:Chorionic Gonadotropin