Clinical and histopathologic evaluation of operated maldescended testes after luteinizing hormone-releasing hormone treatment

Treatment of maldescended testes (MDT) before 2 years of age is recommended in order to avoid degenerative changes of the germinative epithelium. Increased risk of surgical damage to the testis and cord structures in very young boys has been postulated. In order to elucidate this clinical dilemma, a prospective study was carried out in 127 boys with 169 maldescended testes. The age of the patients was 6 months to 11 1/2 years; 18% of the testes descended to the bottom of the scrotum after luteinizing hormone-releasing hormone treatment. Preoperative hormonal therapy should be given to the patients to avoid surgery on testes responding to this treatment. If the hormonal treatment was unsuccessful, orchiopexy with a peroperative testicular biopsy was performed. The numbers of spermatogonia per tubular transverse section of the biopsy specimen were estimated and compared to material from normal autopsy testes. The S/T expressed as a percentage of minimum for age was negatively correlated to the age of the boys at the time of operation. These findings favor early operation. With respect to satisfactory testis size, consistency, and placement in the scrotum, the result of orchiopexy was successful in 89% of the cases. Unfortunately, all but 4 of the children enrolled in this study were over 2 years of age, so we were unable to accurately determine the risk of surgical intervention before the age of 2 years.