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INVESTIGATIVE
UROLOGY
Relationship
between adult dark spermatogonia and secretory capacity of Leydig cells
in cryptorchidism
Zivkovic D, Bica DT, Hadziselimovic F
Institute for Child and Youth Health Care, Paediatric Urology, Novi Sad,
Serbia and Montenegro
BJU Int. 2007; 100: 1147-9
- Objective:
To
examine whether hormonal therapy before orchidopexy affects the histology
of the testis and to assess the responsiveness of the Leydig cells,
as it has been shown that although basal plasma testosterone levels
are within the ‘normal’ range in cryptorchid boys there
is an insufficient increase of testosterone after a human chorionic
gonadotrophin (hCG) stimulation in approximately 30% of cryptorchid
boys.
- Patients
and Methods: In all, 55 boys (aged 1-7 years) with a unilateral
undescended testis were included in the study and divided into two groups.
Group I (32 boys) received hormonal therapy before orchidopexy; 17 boys
received a long-acting LHRH analogue (buserelin) administered as a nasal
spray in doses of 20 microg/day for 28 days, followed by 1500 IU hCG
intramuscularly (i.m.) once a week for 3 weeks, and the remaining 15
received 1500 IU hCG i.m. once a week for 3 weeks. Group II (33 boys)
had orchidopexy alone. During orchidopexy biopsies were taken from the
undescended and contralateral descended testes of the boys in both groups
for histological analyses. Variations in the number of adult dark (Ad)
spermatogonia per tubule (Ad/T) were assessed and testosterone levels
were measured during the course of the hormonal therapy (before treatment,
14 days after initiation of buserelin administration, 24 h after each
hCG injection, and 3 months after cessation of therapy).
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Results:
In group I, 17 boys (53%) had a ‘normal’ Ad/T after hormonal
treatment vs only six (18%) in group II after orchidopexy alone (P =
0.019). In the hormonally treated boys (group I) we compared the testosterone
values 24 h after the second injection of hCG (when the response was
most pronounced). Those with a normal Ad/T had a mean (sd) testosterone
level of 199.5 (97.6) ng/dL vs 99.6 (85) ng/dL in those with an inadequate
Ad/T response to hormonal therapy (P < 0.003).
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Conclusion:
We have confirmed that there are two subgroups of cryptorchid boys.
Patients with a sufficient Leydig cell secretory capacity will have
normal testicular histology and Ad spermatogonia count after hormonal
treatment. While those with a suboptimal Leydig cell capacity will have
a low Ad spermatogonia count and consequently poor prognosis for future
fertility, despite successful surgery. As to whether different types
and durations of the hormonal therapy in patients with impaired Leydig
cell response could lead to improved testicular histology and consequently
improved prognosis for future fertility, remains to be answered.
- Editorial
Comment
This paper presents new important insights on the understanding of cryptorchidism
and its treatment and I will highlight some important points.
The authors demonstrated for the first time, that the transformation
of gonocytes into Ad spermatogonia is a testosterone-dependent process.
If an adequate increase in plasma testosterone follows hormonal stimulation,
normal germ-cell maturation occurs. Patients that have an insufficient
Leydig cell response to hormonal stimulation, resulting in an inadequate
testosterone increase, will have poor testicular histology and a low
Ad spermatogonia count.
Interesting, the authors concluded that appears to be two subgroups
of cryptorchid boys; those with a sufficient Leydig cell secretory capacity
and those with a suboptimal Leydig cell secretory capacity.
Dr.
Francisco J.B. Sampaio
Full-Professor and Chair, Urogenital Research Unit
State University of Rio de Janeiro
Rio de Janeiro, RJ, Brazil |