The Clinical Experience on Orchiectomy in the Postpubertal Unilateral Cryptorchidism

Kang, Kyoung Joong; Kim, Hyun Soo; Oh, Tai Hee

Abstract

PURPOSE: The postpubertal males with unilateral cryptorchidism undergo orchiectomy rather than orchiopexy, which is based on the various reports in its effect on fertility and predisposition to testicular cancer. We reviewed retrospectively the clinical features and histopathological findings of orchiectomized testes and investigated the role of orchiectomy in the postpubertal unilateral cryptorchidism.
MATERIALS AND METHODS
We reviewed 42 patients with postpubertal unilateral cryptorchidism who underwent orchiectomy from 1986 to 1998, retrospectively. Patient`s age ranged from 15 to 47 years(mean 26.4). The cryptorchid testes were palpable in 33 cases(79%) and impalpable in 9 cases(21%). We classified cryptorchid testes histopathologically into 2 broad groups of specimens with no spermatogenesis(severe atrophy and/or Sertoli cell-only syndrome) and specimens displaying spermatogenesis(maturation arrest, hypospermatogenesis). In 38 cases of all orchiectomized specimens, testicular volume was calculated by Lambert`s formula.
RESULTS
Histopathology showed maturation arrest in 8 cases(19%) while 34 cases(81%) had severe atrophy and/or Sertoli cell-only syndrome. No case of carcinoma in situ or cancer was found in testicular tissue. The location of the cryptorchid testes was the prepubic area in 13(31%), inguinal canal in 23(55%), and abdomen in 6(14%). There was a statistically significant difference in the relationship between the presence and absence of spermatogenesis in cryptorchid testes and the anatomical levels of descent(p<0.05). There was no statistically significant difference in the relationship between testicular volume and the location of cryptorchid testes, between testicular volume and patient`s age(p>0.05).
CONCLUSIONS
Currently, orchiectomy is mostly advocated for a postpubertal unilateral cryptorchid testis because of the risk of future malignancy. But we consider that orchiopexy is a valuable modality of treatment for postpubertal unilateral cryptorchid testis, especially located at prepubic area, after performing testis biopsy and then periodic follow-up is required.