Age At Orchiopexy And Testis Palpability Predict Germ And Leydig Cell Loss: Clinical Predictors Of Adverse Histological Features Of Cryptorchidism

Main Category: Urology / Nephrology
Also Included In: Fertility
Article Date: 26 Oct 2009 - 2:00 PDT

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UroToday.com - The association between undescended testes and impaired fertility has been well-studied and well-described. _1-5 Given the readily identifiable anatomic abnormality and the low-risk of surgical intervention, the recommended age at which boys with cryptorchidism undergo orchiopexy has been lowered over the years; currently, most experts recommend orchiopexy prior to 12 months of age.

Our study found that there is a continuous 2% risk per month of severe germ cell depletion and a 1% risk per month of Leydig cell loss for each month a cryptorchid testis remains undescended. Additionally, we found that boys with non-palpable undescended testes are at an increased risk for depletion of Leydig cells compared to boys with palpable undescended testes.

The major question that this study does not answer is if orchiopexy stops or reverses the adverse histologic changes in the cryptorchid testis. While the most definitive study would be to perform biopsies on the undescended testis at the time of repair and at an appropriate length of time after surgery and compare these findings to normal age-matched boys, it is highly unlikely that this could be done given the inherent ethical considerations associated with carrying out this study.

Additionally, this study does not address the related but not as well-described condition of acquired cryptorchidism (i.e. "ascending testes"). Although it appears that the testes of boys with acquired cryptorchidism develop the same histologic changes as those with primary cryptorchidism, it is not known if our findings can be applied to this group. ₅ This may be harder to discern in this group as the time at which the testis "ascends" can be somewhat nebulous and it appears that most children with acquired cryptorchidism have palpable testes.

We look forward to studies that address the unanswered questions. In the meantime, we continue to advocate for prompt referral of children with primary cryptorchidism to pediatric urologists in order to facilitate early orchiopexy. Although it is uncertain whether early intervention can halt the adverse histologic changes we observed, it does appear that lack of intervention will lead to progressive depletion of both Leydig and germ cells in cryptorchid testes, which have been associated with impaired fertility.

1. Trussell, J. C., Lee, P. A.: The relationship of cryptorchidism to fertility. Curr Urol Rep, 5: 142, 2004
2. Lee, P. A., O'Leary, L. A., Songer, N. J. et al.: Paternity after bilateral cryptorchidism. A controlled study. Arch Pediatr Adolesc Med, 151: 260, 1997
3. Lee, P. A., Coughlin, M. T.: Fertility after bilateral cryptorchidism. Evaluation by paternity, hormone, and semen data. Horm Res, 55: 28, 2001
4. Rusnack, S. L., Wu, H. Y., Huff, D. S. et al.: Testis histopathology in boys with cryptorchidism correlates with future fertility potential. J Urol, 169: 659, 2003
5. Rusnack, S. L., Wu, H. Y., Huff, D. S. et al.: The ascending testis and the testis undescended since birth share the same histopathology. J Urol, 168: 2590, 2002

Written by Gregory Tasian, MD, MSc as part of Beyond the Abstract on UroToday.com

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