Acquired cryptorchidism: More harm than thought?
BACKGROUND
Acquired cryptorchidism (AC) has been recognized as a subgroup of undescended testes (UDT). There is growing evidence that the compromising effect equals that of congenital UDT (cUDT). This prospective study included an extensive histological examination of biopsies taken from AC patients.


METHODS
From August 2013 to December 2014, 21 boys (3-12 years of age) underwent testicular biopsy during orchiopexy for AC. Patient and family histories were taken. The amount of germ cells (GC) per tubule (T) and the amount of adult dark spermatogonia (Ad-S) per T were determined by resin semi-thin sections examination. The samples were also scanned for signs of malformation. Immunohistochemical stains were performed as markers for atypical germ cells.


RESULTS
Four (19%) boys were born prematurely, two (9.5%) were small for gestational age (SGA), and nine (43%) had a positive family history of UDT. The median of GC/T was 1.06 in boys <9 years, and 0.60 in boys ≥9 years. The median of Ad-S/T was 0.02 in boys <9 years and 0.01 in boys ≥9 years. There were no signs for malformation and no atypical cells. The immunohistochemical stains were negative in all specimens.


CONCLUSIONS
Prematurity, SGA, and a positive family history appeared to be predictors for AC. Extensive histopathological examination of AC revealed a significant reduction of germ cell count and fertility markers, comparable with that in cUDT. The alterations were more severe in boys aged ≥9 years. It is unclear as to whether or not this was possibly caused by a longer duration of inguinal position, but this finding suggests that routine checks of testicular position throughout childhood are needed, and that there is a cause for continued efforts in educating parents and primary care physicians regarding AC. Current data support the notion of surgical correction once the diagnosis is made.
Department of Paediatric Urology, Klinik St. Hedwig, University Medical Center of Regensburg, Steinmetzstr. 1-3, 93049 Regensburg, Germany. Electronic address: martin.promm@barmherzige-regensburg.de.
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M
Promm
Department of Paediatric Urology, Klinik St. Hedwig, University Medical Center of Regensburg, Steinmetzstr. 1-3, 93049 Regensburg, Germany.
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A
Schröder
Department of Paediatric Urology, Klinik St. Hedwig, University Medical Center of Regensburg, Steinmetzstr. 1-3, 93049 Regensburg, Germany.
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C
Neissner
Department of Pathology, University Medical Center of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany.
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F
Eder
Department of Paediatric Urology, Klinik St. Hedwig, University Medical Center of Regensburg, Steinmetzstr. 1-3, 93049 Regensburg, Germany.
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WH
Rösch
Department of Pathology, University Medical Center of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany.
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J
Schröder
D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D003456:Cryptorchidism / Q000209:etiology / Q000473:pathology*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D013737:Testis / Q000473:pathology*
Acquired cryptorchidism; Ascensus testis; Congenital cryptorchidism; Fertility; Germ cells; Undescended testes