PEDIATRIC UROLOGY

The single testis: paternity after presentation as unilateral cryptorchidism
Lee PA, Coughlin, MT
Penn State University College of Medicine, Hershey, Pennsylvania, USA
J Urol. 2002; 168:1680-3

• Purpose: We determine if paternity is reduced among men with monorchidism (absent or removed testis) compared to men with unilateral cryptorchidism corrected during childhood by orchiopexy and controls. The group of men with an absent testis was determined among males presenting during childhood with only 1 descended testis.
• Materials and Methods: Data were obtained by medical record review and a detailed questionnaire. Only men who had been successful at or attempted paternity for whom we had complete data were included in the study from the entire cohort of 584 men with former cryptorchidism, 23 with absent testis, 26 treated with orchiectomy and 706 controls.
• Results: Percentages of men reporting success after attempting paternity did not differ among men with an absent testis (15 of 15, 100%), treated with orchiectomy (17 of 20, 85.0%), with corrected unilateral cryptorchidism (313 of 349, 89.7%) and controls (412 of 442, 93.2%). There was no difference for a subgroup of men with cryptorchidism judged to have an atrophic testis at orchiopexy (17 of 20, 85%) or those who underwent orchiectomy at initial attempted orchiopexy (8 of 10, 80%) and men who had subsequently undergone orchiopexy (9 of 10, 90.0%). Paternity was also not reduced in the group of men with only 1 testis (32 of 35, 91.4%) (monorchism plus orchiectomy) compared to either the corrected unilateral cryptorchid group or the control group. Of 637 testes 183 were recorded as impalpable on examination before surgery and 23 testes were absent, including 7 recorded as palpable. In fact, 12.1% (23 of 190) of testes that should have been recorded as impalpable were absent.
• Conclusions: This study failed to indicate that paternity is diminished among men with a single testis compared with the general population, regardless of the origin of the loss. About 12% of unilateral impalpable testes judged to be impalpable on examination before surgery were found to be absent after surgical exploration.
  
  
• Editorial Comment
  Cryptorchidism is one of the most common urological conditions, affecting almost 1% of the male population (1). The etiology of the condition remains unclear, but it may be due to a mechanical problem (abnormal gubernaculum) or a hormonal problem (hypogonadism). Anatomical anomalies (an abnormal epididymis) coexist and studies in adults have suggested that even after appropriate surgical intervention, the previously undescended testis contributes little to long-term sperm production (2). Questions remain about the long-term follow-up of these patients.
  The authors reviewed paternity in these patients (and in a control population) by questionnaire. Their findings were that patients with a history of unilateral cryptorchidism had a paternity rate of 90% vs. 93% in controls and 91% in patients with unilateral anorchia. None of these differences were statistically significant.
  Despite a focus on early orchiopexy and hormonal therapy (even after successful orchiopexy) it is unclear if we are really making a difference for these patients (3,4). The fact that there is little difference in paternity in patients undergoing orchiopexy should be very reassuring to parents and surgeons.

References
1. Scorer C: The descent of the testis. Arch Dis Child. 1964; 39:605.
2. Kogan BA, Gupta R, Juenemann KP: Fertility in cryptorchidism: further development of an experimental model. J Urol. 1987; 137:128-31.
3. Hadziselimovic F, Herzog B: The importance of both an early orchidopexy and germ cell maturation for fertility. Lancet 2001; 358:1156-7.
4. Hadziselimovic F, Herzog B: Importance of early postnatal germ cell maturation for fertility of cryptorchid males. Horm Res. 2001; 55: 6-10.

Dr. Barry A. Kogan
Chief and Professor of Urology and Pediatrics
Albany Medical College
Albany, New York, USA