Document Detail

Neoadjuvant gonadotropin-releasing hormone therapy before surgery may improve the fertility index in undescended testes: a prospective randomized trial.
MedLine Citation:
PMID:  15711353     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Subfertility is considered the principal consequence of cryptorchidism even after timely orchiopexy. Gonadotropin-releasing hormone (GNRH) treatment appears to improve fertility later in life by inducing germ cell maturation. In a prospectively randomized trial we investigated whether preoperative GNRH therapy improves the fertility index in primary cryptorchidism. MATERIALS AND METHODS: A total of 42 boys 11 to 100 months old (median 33.5) with 63 undescended testes were prospectively assigned to 2 groups during a 6-month period. Patients were randomized to receive either orchiopexy alone (21 patients) or with neoadjuvant GNRH therapy (21) as a nasal spray for 4 weeks at 1.2 mg per day. In both groups testicular biopsies were performed at the time of orchiopexy and histopathological fertility index was determined. RESULTS: Mean fertility index in the group treated with GNRH before surgery was significantly higher (1.05, SD +/- 0.71) compared to the group without hormonal stimulation (0.52, SD +/- 0.39, p <0.05). The subgroup of neoadjuvant stimulated boys younger than 24 months achieved the best results compared to the age matched boys without hormonal treatment. CONCLUSIONS: Neoadjuvant GNRH treatment improves fertility index in prepubertal cryptorchidism. Consequently, preoperative hormone therapy should improve fertility in adulthood. Additionally, the nasal application is well tolerated, safe and already recommended in an adjuvant setting after orchiopexy. Maximum salvage of active germinal tissue is achieved by treating cryptorchidism before the end of the first year of life.
Christian Schwentner; Josef Oswald; Alfons Kreczy; Andreas Lunacek; Georg Bartsch; Martina Deibl; Christian Radmayr
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  The Journal of urology     Volume:  173     ISSN:  0022-5347     ISO Abbreviation:  J. Urol.     Publication Date:  2005 Mar 
Date Detail:
Created Date:  2005-02-15     Completed Date:  2005-03-29     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0376374     Medline TA:  J Urol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  974-7     Citation Subset:  AIM; IM    
Department of Pediatric Urology, Medical University Innsbruck, Innsbruck, Austria.
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MeSH Terms
Chemotherapy, Adjuvant
Child, Preschool
Cryptorchidism / complications,  drug therapy*,  surgery
Gonadotropin-Releasing Hormone / therapeutic use*
Infertility, Male / etiology,  prevention & control*
Preoperative Care
Prospective Studies
Reg. No./Substance:
33515-09-2/Gonadotropin-Releasing Hormone

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