Comparison of five different hormonal treatment protocols for children with cryptorchidism.
OBJECTIVE
To compare the effects of medical therapy on boys with cryptorchidism, a prospective study was carried out in five groups of patients over a 30-month period.


METHODS
A total of 439 boys with undescended testicles were enrolled; their ages ranged between 6 months and 13 years (median 4.2 years). Of these, 327 had true unilateral and 112 bilateral undescended testicles. In 115 patients surgery was performed directly either because the condition was associated with inguinal hernia or because the child had undergone previous inguinal surgery; hormonal treatment was attempted in the remaining 324 patients. Human chorionic gonadotrophin (hCG) was administered to 113 patients (34.8%), luteinizing hormone-releasing hormone (LH-RH) to 85 (26.2%), a combination of LH-RH and hCG to 64 (19.7%), human menopausal gonadotrophin (hMG) to 35 (10.8%) and a combination of hMG and hCG to 27 (8.3%).


RESULTS
Overall, testicular descent was achieved in 27.7% (90/324) of patients: specifically, in 38.2% (36/94) of boys with bilateral undescended testicles (both testes in 22/36, one testis only in 14/36) but in only 23.4% (54/230) of those with unilateral undescended testicles (p = 0.007). The correlation between the type of therapy and testicular descent can be summarized as follows: hCG, 39/113 (34.5%); LH-RH, 25/85 (29.4%); hCG+LH-RH, 19/64 (29.6%); hCG+hMG, 7/27 (25.9%); hMG alone, 0/35 (0%).


CONCLUSIONS
In our experience, pharmacological treatment seems to yield better results in cases of bilateral than unilateral cryptorchidism. hCG seems to be equally effective as LH-RH for the treatment of cryptorchidism in approximately 30% of cases; the combination of these two drugs does not seems to increase the success rate. The use of hMG alone is ineffective. We believe that hormonal treatment can lead to acceptable results in boys with cryptorchidism, without relevant adverse effects.
Esposito
Ciro
C
Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy. ciroesp2@unicz.it
De Lucia
Amalia
A
Palmieri
Assunta
A
Centonze
Antonella
A
Damiano
Rocco
R
Savanelli
Antonio
A
Valerio
Giuliana
G
Settimi
Alessandro
A
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006063:Chorionic Gonadotropin / Q000627:therapeutic use*; D003456:Cryptorchidism / Q000175:diagnosis / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D007987:Gonadotropin-Releasing Hormone / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D008297:Male; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
D006063:Chorionic Gonadotropin; D007987:Gonadotropin-Releasing Hormone