The impact of age and laterality on the response of gonadotropin hormone therapy (HCG)‎ in undescended testes

Abstract EN

Purpose : to evaluate the role of Gonadotropin (HCG) Hormone in bilateral and unilateral undescended testis in young and old age children, and its benefit for descent, with surgical outcome results after therapy.

Material and Method: A prospective study on 117 patients (147 testis) with cryptorchidism, evaluated in AL-KUT general hospital from April 2005 to April 2009.Thirty of them with bilateral undescended (60 testis), and 87 patients with unilateral undescended testis, 19 testis were impalpable and 128 testis were palpable.

Patients divided into two group according to their age, from one years to five years 85 patients (110 testis) [25 bilateral (50 testis) and 60 unilateral], given 500 IU of HCG weekly intramuscularly for five weeks, and second group 32 patients (37testis) [5 bilateral (10 testis) and 27 unilateral] from five years to eight years, given1500 IU of HCG weekly intramuscularly for five weeks.

Then patients were evaluated clinically, for descent and palpability.

All patients not response to therapy and those with partial descent, orchiopexy done for them, and surgical outcome results were evaluated.

Results : descent occur more in bilateral undescended testis (33.3 %) than unilateral group (10.3 %), and more in younger age group (22.7 %) than older age group (10.8 %).

We found that 5 testis (26.3 %) were palpable from 19 impalpable testis, all of them young age group, while 50 low canalicular palpable testis become prescrotal (39 %).

We achieve success rate of 19.7 % dropped after one year to (10 %) due to relapse in 15 testes.

The surgical outcome was objective as easily descent to scrotum with short time of manipulation due to long spermatic cord with easily hernial sac isolation.

Conclusion: HCG treatment should be limited to those young children with bilateral low undescended testes and as combination therapy with surgery to facilitate surgical descent ; otherwise HCG treatment in older age will delay the operative procedure.