Acquired cryptorchidism - more harm than thought?

• Published in: Journal of pediatric urology Vol. 12; no. 4; pp. 236.e1 - 236.e6
• Main Authors: Promm, Martin, Schrptor, Josef, Neissner, Claudia, Eder, Fabian, Schrsner, Annette, Ridis, Wolfgang H
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.08.2016
• Subjects: Acquired cryptorchidism; Ascensus testis; Biopsy; Child; Child, Preschool; Congenital cryptorchidism; Cryptorchidism - etiology; Cryptorchidism - pathology; Fertility; Germ cells; Humans; Male; Pediatrics; Prospective Studies; Testis - pathology; Undescended testes; Urology; Congenital cryptorchidism; Germ cells; Fertility; Undescended testes; Ascensus testis; Acquired cryptorchidism
• ISSN: 1477-5131; 1873-4898
• DOI: 10.1016/j.jpurol.2016.04.010

Abstract Introduction The 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). We performed an extensive histological examination of biopsies taken from AC patients in a prospective study. Patients and Methods From 08/2013 to 12/2014, 21 boys (3-12 years of age) underwent a testicular biopsy during orchiopexy for AC. Patient and family histories were taken. The amount of germ cells (GC) per tubule (T), as well as the amount of adult dark spermatogonia (Ad-S) per T were determined by resin semithin sections examination. We also scanned the samples for signs of malformation. Immunohistochemical stains (PLAP, OCT 4) as markers for atypical germ cells were performed. Results Four (19%) boys were born prematurely, 2 (9.5%) were small for gestational age (SGA). Nine (43%) boys 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. PLAP and OCT 4 stains were negative in all specimens. conclusions Prematurity, SGA and a positive family history appear to be predictors for AC. Extensive histopathological examination of AC revealed a significant reduction of germ cell count and fertility markers, comparable to that in cUDT. The alterations were more severe in boys older than 9 years. Whether or not this is caused by a possibly longer duration of inguinal position is unclear, 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 supports the notion of surgical correction once the diagnosis is made.