Human chorionic gonadotrophin hormone for treatment of congenital undescended testis: Anatomical barriers to its success

Abstract

Background/purpose: Although the surgical treatment was proved to be the recommended line of management for congenital undescended testis, hormonal therapy with human chorionic gonadotrophin hormone has been started long years ago and is still used in some areas with variable degrees of success. The factors responsible for treatment failure are not well explored. In this study, we aimed to highlight the anatomical abnormalities in the congenital undescended testis that might contribute to treatment failure.

Methods: During the period from January 2014 to December 2015, 75 boys with congenital undescended testes received treatment with human chorionic gonadotrophin, in pediatric surgery department, Faculty of medicine, Ain Shams University. Their age ranged between 6 months and 4 years (mean 1.6 years, median 2 years). In 70 boys, the testes were palpable and in the remaining 5 boys, the testes were impalpable. Fifty boys had unilateral and 25 had bilateral undescended testes. Seven of the palpable testes were high scrotal in position and the remaining 83 were palpated in the inguinal canal. The patients were followed up for 6 months to determine the position of the testis after the treatment and surgical intervention was done for those who did not respond to the hormonal treatment either partially or completely.

Results: Only 7 testes showed complete descent (7%) (2 bilateral and 3 unilateral) and they were initially high scrotal in position, 8 testes showed partial descent (8%) (2 bilateral and 4 unilateral) and they were inguinal in 6 which became high scrotal and impalpable in 2 which became peeping. The remaining 85 (85%) did not respond to the hormonal treatment. Upon surgical exploration, abnormal attachment of the gubernaculum was found in 83 testes (83%), 2 testes were peeping (2%), short testicular vessels were found in 4 testes (4%), 3 testes were vanishing (3%) and a closed internal ring was found in one testis (1%).

Conclusions: Treatment of congenital undescended testis with human chorionic gonadotrophin hormone had low success rates. Anatomical abnormalities in the congenital undescended testis might contribute to this treatment failure.

Type of the study: Clinical research paper.

Level of evidence: level III.

Keywords: Gubernaculum; Hormonal therapy; Human chorionic gonadotrophin; Undescended testis.