Cryptorchidism : value of orchidopexy in adults

摘要

Introduction : Undescended testis is a frequent congenital disease, more often diagnosed and treated during childhood. However, due to ignorance or negligence, this disease can be seen even after puberty, when it raises a therapeutic problem: is orchidopexy still useful? This study was designed to evaluate the outcome of orchidopexy at adulthood in terms of improvement of fertility and prevention of malignant degeneration. Material and methods : Retrospective study performed over a 23-year period (1983-2005). We have found 259 patients with undescended testis diagnosed and treated after the age of 18 years. Results : The mean age of patients was 24 years (range: 18-63). In the majority of cases, undescended testis was diagnosed at a systemic medical examination in 199 patients (77 of cases), and in a context of infertility in 33 patients, testicular malignancy in 8 patients, testicular torsion in 2 patients and, in 17 cases, undescended testis had been known since birth but was neglected by the parents. Undescended testis was unilateral in 209 cases and bilateral in 50 cases. Out of 37 couples, only 4 gave birth to children (10.8 paternity rate). Sperm analysis was abnormal in all infertile patients. All patients were treated by orchidopexy, except for 36 patients in whom orchidectomy was performed due to testicular atrophy (27 cases), malignancy (8 cases) or necrosis (1 case). Biopsy of the intrascrotal testis was performed in 3 patients with unilateral cryptorchidism. Histological examination was normal in two cases and abnormal in one case. The long-term outcome was characterized by: 1. Testicular atrophy in 6 patients (2.7 of cases). 2. Progression to malignancy in 3 patients (1.3 of cases). 3. Improvement of sperm parameters in 16 of 33 infertile patients (48.5); 4 patients fathered children after treatment. Conclusion : Orchidopexy at adulthood can lead to improvement of infertility. It can also decrease the incidence of malignancy and facilitate clinical examination looking for possible malignancy. However, the best treatment remains preventive, based on early diagnosis and orchidopexy.