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JOURNAL COMPILATION 2 0 0 7 B J U I N T E R N A T I O N A L | 1 0 0 , 11 4 7 11 4 9 | doi:10.1111/j.1464-410X.2007.07034.x 11 4 7
Z I V K O V I C ET AL.
types and durations of the hormonal therapy FIG. 1. The percentage of testicular biopsies with an FIG. 2. The plasma testosterone levels after the
in patients with impaired Leydig cell response Ad/T > 0.1 in boys treated hormonally (group I) and second injection of hCG in boys that achieved a
could lead to improved testicular histology those treated with orchidopexy alone (group II). normal Ad spermatogonia count after completion
and consequently improved prognosis for of the treatment (Ad/T > 0.1) and in those that still
PATIENTS AND METHODS The boys were subdivided in two groups We compared the testosterone values 24 h
according to their Ad/T value: Ad/T >0.1, those after the second injection of hCG (when the
Boys aged 17 years, with a unilateral with a normal number of Ad spermatogonia response was most pronounced) in boys from
undescended testis were included in the [1] after treatment and Ad/T 0.1, those with group I: the mean (SD) testosterone level in
study. Boys with retractile testes were inadequate response to hormonal therapy. boys with a Ad/T of >0.1 was 199.5 (97.6) ng/
excluded. Group I consisted of 32 boys treated The number of boys with a normal number of dL vs 99.6 (85) ng/dL in those with an Ad/T
hormonally; 17 received a long-acting LHRH Ad spermatogonia from group I and II was 0.1 (P < 0.003) (Fig. 2).
analogue (buserelin) administered as a nasal compared to determine whether hormonal
spray in doses of 20 g/day for 28 days, stimulation had any effect on the histology of
followed by 1500 IU hCG i.m. once a week for the testis. DISCUSSION
3 weeks, and 15 received 1500 IU hCG i.m.
once a week for 3 weeks. Even though there In group I, the response to the second The effects of hormonal therapy on the
were patients undergoing different protocols injection of hCG was compared between contralateral descended testis have been
of hormonal therapy, we have considered the boys in two Ad/T subgroups of sporadically studied [6]. Bergada et al. [6]
them as one group, as it was shown that hCG group I. found stimulated maturation of germ cells
and LHRH seem to be equally effective in in treated patients, which was directly
treating cryptorchidism [4]. During the course Parental consent was obtained for all patients related to both the dose and duration of
of the hormonal therapy, testosterone levels for hormonal and surgical treatment. The the treatment. In the present study there
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Ad SPERMATOGONIA AND SECRETORY CAPACITY OF LEYDIG CELLS IN CRYPTORCHIDISM
was a significant difference in the histology CONFLICT OF INTEREST 6 Bergada C, Mancini RE. Effects of
of the testes of the boys who had orchidopexy gonadotropins in the induction of
alone and those who received hormonal None declared. spermatogenesis in human prepubertal
therapy of any kind beforehand; the Ad/T was testis. J Clin Endocrinol Metab 1973; 37:
significantly higher in the hormonally treated 93543
boys. It has been shown that the number of
Ad spermatogonia is correlated to future REFERENCES Correspondence: Faruk Hadziselimovic,
fertility [2]. The effects of testosterone on Kindertagesklinik, Oristalstrasse 87a, CH-4410
the transformation of gonocytes into Ad 1 Hadziselimovic F, Emmons LR, Buser M. Liestal, Switzerland.
spermatogonia have not yet been analysed. A diminished postnatal surge of Ad e-mail: faruk@magnet.ch;
We have shown in the present study, for spermatogonia in cryptorchid infants is zdragana@eunet.yu
the first time, that the transformation of additional evidence for hypogonadotropic
gonocytes into Ad spermatogonia is a hypogonadism. Swiss Med Wkly 2004; Abbreviations: Ad, adult dark; Ad/T, Ad
testosterone-dependent process. If an 134: 3814 spermatogonia per tubule.
adequate increase in plasma testosterone 2 Hadziselimovic F, Herzog B. The
follows hormonal stimulation, normal importance of both an early orchidopexy
germ-cell maturation occurs. Patients that and germ cell maturation for fertility. EDITORIAL COMMENT
have an insufficient Leydig cell response Lancet 2001; 358: 11567
to hormonal stimulation, resulting in an 3 Forest MG. Pattern of the response This interesting and significant paper from a
inadequate testosterone increase, will have to hCG stimulation in prepubertal group who has pioneered our understanding
poor testicular histology and a low Ad cryptorchid boys. In Job CL ed., of the endocrinopathy causing
spermatogonia count. Cryptorchidism, Diagnosis and Treatment. cryptorchidism and its effect on fertility adds
Pediatr Adolesc Endoc. Basel: Karger, further insight into this problem. This is new
In conclusion, from the present study there 1979: 10820 data that appears especially relevant in an era
appears to be two subgroups of cryptorchid 4 Esposito C, De Lucia A, Palmieri A et al. when male adult fertility appears to be
boys; those with a sufficient Leydig cell Comparison of five different hormonal decreasing. This paper deserves careful study
secretory capacity and those with a treatment protocols for children with and should pave the way toward a better
suboptimal Leydig cell secretory capacity. As cryptorchidism. Scand J Urol Nephrol understanding of both cryptorchidism and
to whether different types and durations of 2003; 37: 2469 fertility.
hormonal therapy in cryptorchid boys with 5 Bica DT, Hadziselimovic F. Buserelin
impaired Leydig cell response could lead treatment of cryptorchidism: a Howard M. Snyder III, MD,
to improved testicular histology and randomized, double-blind, placebo- Division of Urology, Department of Surgery,
consequently improved prognosis for future controlled study. J Urol 1992; 148: The Childrens Hospital of Philadelphia,
fertility, remains to be answered. 61721 Philadelphia, PA, USA
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