An Endocrinologic Follow-up Study of Operated Cases of Cryptorchism

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Abstract
Of 200 boys operated on for cryptorchism between the ages of 1 and 14 yr, 93 had a detailed follow-up examination between the ages of 12 and 27 yr and a further 29 answered a questionnaire only. Of the 93 subjects examined, 6 had some obvious endocrine disease: 3 had Klinefelter's syndrome (2 XXY and 1 XXYY), 2 hypogonadotrophic hypogonadism, and 1 germinal cell aplasia. The clinical features of these 6 cases and 2 others with initially azoospermic semen are described. In the other 85 subjects there was no pathologic delay of sexual development in relation to chronologic age, according to physical examination supplemented by radiographic determinations of skeletal age. Anatomically, the operation had been successful in all but 2 cases. Forty-one patients delivered a semen specimen. Among 22 patients who had undergone bilateral operation, 7 were normospermic, 12 oligospermic, and 3 azoospermic. Of 19 patients operated on for one-sided cryptorchism 14 were normospermic and 5 oligospermic. The ages of the patients at the follow-up study did not allow an evaluation of the fertility of those who were operated on when less than 9 yr old. Among those operated on between the ages of 9 and 13 yr, 10 reported fatherhood (2 of them bilateral cases). Among subjects over the age of 20, 44% (33% in bilateral involvement) were in all probability potentially fertile, judging from the semen investigation and reported fatherhood. These are minimum figures, which may well be exceeded eventually. It is concluded that all boys with cryptorchism should be investigated endocrinologically before surgical intervention is advised. With the operative method used in this series, the anatomic results are highly gratifying and normal genital maturation is apparently not disturbed. Finally, the results support the view that surgical correction of cryptorchism, even if not performed until early puberty, may well result in satisfactory fertility.