Early successful orchidopexy does not prevent from developing azoospermia.
BACKGROUND
The incidence of Ad spermatogonia (stem cells for fertility) was assessed in 20 cryptorchid patients, all of whom had a successful orchidopexy in childhood but developed azoospermia following puberty.


METHODS
From a cohort of 231 patients who had a semen analysis following successful orchidopexy 20 patients (9%) had azoospermia. The patients were classified into 2 groups according to the time of surgery: A = < 21 months of age (n = 5, mean = 10.7 +/- 8.6 months) and B = during childhood (n = 15, mean = 10.1 +/- 3 years). Nine of the 20 patients (45%) had bilateral cryptorchidism: A = 1 and B = 8. Testicular biopsies were performed during orchidopexy and analyzed with semi-thin technique. The number of Ad spermatogonia and entire number of germ cells was determined. The patients' semen analyses were evaluated at least twice; FSH and testosterone plasma values were estimated.


RESULTS
In group A, all patients had germ cells at the time of surgery (mean = 1.04 +/- 1.4 germ cells per tubular cross section); only 6 patients in group B (40%) had no germ cells (mean = 0.17 +/- 0.4); A vs. B, p = 0.0133. Importantly, Ad spermatogonia were absent in the entire study population. The plasma FSH of 16 patients (80%) was abnormal [median = 16.35 IU/L (Interquartile range of sample - IQR 9.075-27.85 95% CI, 3-53)] while the plasma testosterone of all the patients was normal.


CONCLUSIONS
The most severe cause of infertility in cryptorchid patients cannot be mitigated by an early successful surgery alone.
Hadziselimovic
Faruk
F
Kindertagesklinik Liestal, Liestal, Switzerland. faruk@magnet.ch
D000293:Adolescent; D053713:Azoospermia / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D015331:Cohort Studies; D003456:Cryptorchidism / Q000097:blood / Q000150:complications / Q000601:surgery*; D005640:Follicle Stimulating Hormone / Q000097:blood*; D006801:Humans; D008297:Male; D009919:Orchiectomy; D013076:Sperm Count; D013093:Spermatogonia; D013739:Testosterone / Q000097:blood*
D013739:Testosterone; D005640:Follicle Stimulating Hormone