Acquired undescended testes and fertility potential: is orchiopexy at diagnosis better than awaiting spontaneous descent?

• Published in: Andrology (Oxford) Vol. 3; no. 4; pp. 677 - 684
• Main Authors: Plas, E. M., Brakel, J., Meij‐de Vries, A., Muinck Keizer‐Schrama, S. M. P. F., Hazebroek, F. W. J., Hack, W. W. M., Dohle, G. R.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.07.2015
• Subjects: acquired cryptorchidism; Adolescent; Adult; Age Factors; Child; Child, Preschool; Cryptorchidism - diagnosis; Cryptorchidism - surgery; Fertility; Gonadal Hormones - blood; Humans; Male; Orchiopexy; Regression Analysis; Retrospective Studies; Semen Analysis; undescended testis; Watchful Waiting; Young Adult; acquired cryptorchidism; undescended testis; fertility; orchiopexy
• ISSN: 2047-2919; 2047-2927
• DOI: 10.1111/andr.12044

Summary The aim of this study was to evaluate testicular function in men with previous acquired undescended testis (UDT) in whom orchiopexy was performed at diagnosis compared with a similar group of men in whom spontaneous descent was awaited until puberty. Secondly, we examined the influence of age at orchiopexy on fertility parameters in adult life. A total of 169 men of the ‘orchiopexy at diagnosis’ group and 207 men of the ‘wait and see’ protocol group were invited for participation. All participants underwent an andrological evaluation, including medical history, physical examination, scrotal ultrasound, determination of reproductive hormones, and semen analysis. Results were compared for men in whom orchiopexy was performed at diagnoses with men in whom spontaneous descent was awaited until puberty followed by orchiopexy in case of non‐descent. In the ‘orchiopexy at diagnosis’ group, 63 men of whom 14 with bilateral UDT, and in the ‘wait and see’ protocol group, 65 men of whom 15 with bilateral UDT were included. For unilateral UDT Inhibin B was found to be significantly lower and median progressive motility was higher in men with orchiopexy at diagnosis. For bilateral UDT, semen concentration and progressive motility showed a trend toward a favorable outcome for orchiopexy at diagnosis. Age at orchiopexy being under or above 10 years of age had no significant influence on the fertility potential. The outcome of physical examination, scrotal ultrasound, endocrine function, and semen analysis indicates a compromised fertility potential in men with previous acquired UDT. None of the protocols proved to be superior. For bilateral UDT, a trend toward favorable outcome of orchiopexy at diagnosis was seen. Furthermore, age at orchiopexy did not have an influence on fertility parameters. Therefore, in our opinion a ‘conservative policy’ is warranted for unilateral UDT, especially because over 50% of acquired UDT descend spontaneously.