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In 56 boys more than 6 month of age with cryptorchidism, luteinizing hormone releasing hormone (LHRH) was administered as a nasal spray 1.2 mg/day for 4 weeks. The nonresponders received human chorionic gonadotropin (HCG) 500 IU i.m. three times a week for 3 weeks. With the combined treatment, 46.5% of testes descended into the scrotum. Testicular descent occured more often in patients whose testes were located in a lower position. The initial position of the testes at clinical examination correlated significantly with the position at surgical inspection and the extent of epididymal malformation: the higher the clinical position of the testes, the more pronounced the maldescent and epididymal malformation. Histological findings indicated a paucity of germinal epithelium and atrophy of the Leydig cells. A significant inverse correlation existed between age at surgery and number of spermatogonia. Therefore, we advocate the earliest feasible treatment for cryptorchidism with a combination of LHRH and HCG, and for non-responders a surgical corrective procedure. [ABSTRACT FROM AUTHOR]

The epididymis is one of two organs which during the process of development in certain mammalian species descends from the dorsal abdominal wall into the scrotum. This phenomenon may or may not be accompanied by the testis during the descent, and it requires androgens. Androgen deficiency experimentally achieved induced cryptoepididymis. Both, experimentally with E2B induced as well as naturally occurring cryptoepididymis can be successfully treated with either HCG or LH-RH or a combination of both. [ABSTRACT FROM AUTHOR]

This randomized double-blind, placebo-controlled study was initiated to analyze the behavior of epididymis, processus vaginalis and testicular descent in cryptorchid boys treated with a low dose (20 micrograms) of a luteinizing hormone-releasing hormone analogue (Buserelin), administered daily, as a nasal spray, for a short period (28 days). Fifty-nine true cryptorchid boys were randomly assigned to 3 groups: buserelin treatment [22], surgical treatment [18] or placebo control group [19]. The 3 groups of patients were similar before treatment in regard to testicular position, chronological and bone age, height and weight, luteinizing hormone, follicle-stimulating hormone, testosterone, penile size and the volume of the contralateral descended testis. None of the patients had retractile testes. Buserelin significantly induced testicular descent compared to the boys treated with a placebo (P < 0.01). A normal epididymis was found more often in boys with successful descent (P < 0.003). A closed processus vaginalis was also more frequently observed in the group treated with buserelin than in surgically treated one (P < 0.05). In conclusion, buserelin was capable of inducing testicular descent besides provoking further development of the epididymis and closing the processus vaginalis. [ABSTRACT FROM AUTHOR]

Daily subcutaneous doses of luteinizing hormone-releasing hormone (LHRH) analogues are a well-established therapy for gonadotropin-dependent precocious puberty. Reports on intranasally administered analogues, however, are controversial. We studied the effect of intranasal D-Ser(TBU)6-LHRH(BUS) on growth rate, skeletal maturation, and urinary gonadotropins in five girls and one boy with central precocious puberty (CPP) who had been treated for 1.4-2.3 years (mean 1.9). Because of the potential antifertility effects of LHRH analogues, testicular histology was analysed in the boy. In the five children with accelerated growth, the bone age-related velocity of height gain decreased from 10.58 +/- 2.77 to 5.82 +/- 1.8 cm/year (means +/- SD, P less than 0.01), and the ratio of change in bone age to change in chronological age fell below 1. Basal luteinizing hormone (LH), and LHRH-stimulated LH and follicle stimulating-hormone, at pubertal levels before treatment, decreased significantly in all children, normalizing in four (P less than 0.04). During therapy, pituitary function was best controlled by urinary LH, which correlated with clinical data. After 13 months of therapy, testicular histology showed degenerated Sertoli cells, and absence of B- and Ap-spermatogonia and of primary spermatocytes in the boy. We conclude that: (1) Efficient long-term suppression of central precocious puberty--including accelerated growth and skeletal maturation--can be maintained by intranasal dosage of BUS. (2) Urinary LH reflects pituitary function and proves to be a reliable guide to adjustment of the LHRH-analogue dose regimen.(ABSTRACT TRUNCATED AT 250 WORDS) [ABSTRACT FROM AUTHOR]

This long-term prospective follow-up study showed that in cryptorchid patients a significant correlation exists between the number of germ cells at the time of orchiopexy (prepuberty) and the spermiogram, and thus a biopsy has a prognostic value. Fifty percent of our patients had a germ cell count of less than 0.1 per tubule and belong to the risk group for sterility. Successful surgery could not induce a significant increase of germ cells in the risk group, although it does prevent secondary testicular damage. Patients with cryptorchidism developed after birth have significantly better chances of fertility than those with primary cryptorchidism. The priming effect of testosterone in the first months of life is important for male fertility. In patients belonging to the risk group treated with buserelin, a significant age-dependent increase in germ cell count occurred. [ABSTRACT FROM AUTHOR]

Development of normal germ cells during childhood is a continuous process which ends at puberty. Cryptorchid gonads have severe impairment of their germ cell development which is more pronounced the higher the gonads are situated. However, all newborns with intra-abdominal testes had a normal number of germ cells. This strongly supports the theory that cryptorchidism is a disease and not a malformation. As a consequence, adequate and early treatment of cryptorchid boys should be undertaken in order to preserve good chances of fertility. [ABSTRACT FROM AUTHOR]

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The fine structure of the crystalloid in spermatogonia has been studied in biopsies from 18 children and compared with the crystalloid in Sertoli cells. The crystalloid of Lubarsch can be seen already in 4-month-old children and it grows larger with age. Furthemore we have discussed the origin of spermatogonial crystalloids. [ABSTRACT FROM AUTHOR]

In 238 boys with cryptorchidism, between the ages of 4 and 48 months, luteinizing hormone releasing hormone (LHRH) was administered as nasal spray 1.2 mg/day for 4 weeks. The nonresponders received human chorionic gonadotropin (HCG) 500 I.U. i.m. three times a week for 3 weeks. With the combined treatment 37.8% of testes descended into the scrotum. Testicular descent occurred more often in patients whose testes were located in a lower position. Histological findings indicated a reduction in the number and maturation of germ cells. A clear improvement of germ cells trophism was observed in boys hormonally treated and operated on before the 12th month of life. Early administered combined treatment with LHRH and HCG can be considered as a substitution of the gonadotropins insufficiency manifested by most cryptorchid infants in the first months of life. [ABSTRACT FROM AUTHOR]

In a collaborative study, 48 prepubertal boys with undescended testes ranging in age from 15 months to 11 years were treated with low-dose intranasal buserelin following an every-other-day programme for a period of 6 months. Urinary LH, FSH, and testosterone were not altered during the treatment period. Boys over 7 years of age experienced a slight but significant rise in testosterone at the end of treatment. Testicular descent was achieved in only 17% of boys. In the remainder, bilateral testicular biopsies were obtained during orchiopexy. Grouped analysis showed a significant increase in the number of germ cells per tubule in both unilateral and bilateral cryptorchid boys, suggesting that buserelin treatment of the testis in a cryptorchid position is capable of improving fertility potential. If time-matched controls are compared to treated boys of the same age, again a significant difference is observed indicating that buserelin treatment does increase the germ cell count. [ABSTRACT FROM AUTHOR]

The assay of urinary LH and FSH in first morning void urine can be used for the differential diagnosis between anorchism and bilateral cryptorchidism with impalpable testes. Furthermore, levels of urinary LH and FSH excretion and their response to intranasal stimulation with LH-RH prove helpful in the follow-up of patients under hormonal treatment, i.e. prolonged stimulation in hypogonadotrophic hypogonadism or suppression by an LH-RH analogue, for instance in precocious puberty. By increasing the sensitivity of the assay, the value of urinary gonadotrophins for the differential diagnosis and survey of hormonal treatment in very young children can be examined, and investigations of this kind are currently taking place. The method used obviously cannot assess the bioactivity of the excreted hormone, nor can it depict the pulsatility of gonadotrophin secretion. [ABSTRACT FROM AUTHOR]

One hundred and fifteen biopsies from unilateral cryptorchid prepubertal patients were embedded in Epon. Semithin sections were examined by light microscope and the germ cell count per tubule was calculated. The mean number of germ cells was normal from birth to 12 months of age and dropped below the lower limits of normal between 1 and 2 years. Germ cell counts rose considerably during the 18-months observation period with the highest counts occurring in the last 6 months. Variability in the clinical diagnosis of cryptorchidism or inherent heterogeneity in the testicular histology of cryptorchidism are possible explanations. [ABSTRACT FROM AUTHOR]

1. (a) Primary and secondary testicular atrophy is caused by ischaemia, most frequently after intrauterine and prepuberal testicular torsion. (b) After standard orchiopexy, and especially after orchiopexy in high undescended testis, secondary testicular atrophy is frequent. (c) The histological condition of a cryptorchid testis does not predict atrophy. Immediate detorsion and/or prophylactic fixation as well as subtle technique in orchiopexy are essential. 2. Sympathetic orchiopathy of a unilateral atrophic testis was not proven in cryptorchidism and testicular torsion. There is considerable evidence of primary bilateral disease. 3. Testicular atrophy as an aetiological factor in the development of testicular tumor remains open to debate. [ABSTRACT FROM AUTHOR]

A cryptorchid testis within an open processus vaginalis is a frequent operative finding. An almost obligate additional epididymal dissociation (90%) and a ST-Index (Spermatogonia per tubulus) of 0-0.2 in over 50% of the patients are an indication of a complex and severe form of cryptorchidism. Postoperative treatment with a LHRH-analogon (Buserelin) is recommended. [ABSTRACT FROM AUTHOR]

In the last 12 years, 916 cryptorchid testes have been treated sequentially with therapeutic and surgical procedures. Although the age of the boys varied considerably at the time that corrective procedures commenced, the best results were obtained when they were in the first year of life. The testes of the boys at this age who had been treated had a normal histology; this was not the case of those who were treated at an age older than one year. [ABSTRACT FROM AUTHOR]