Journal of Andrology, Vol. 24, No. 2, March/April 2003
Copyright © American Society of Andrology
Editorial Commentary
Professor John M. Hutson, Director
Department of General Surgery
Royal Children's Hospital
Flemington Road
Parkville VIC 3052 Australia
Thonneau PF, Candia P, Mieusset R. Cryptorchidism: incidence, risk factors,
and potential role of environment; an update. J Androl.2003
;24:155–162.[Free Full Text]
The review of cryptorchidism by PF Thonneau and others is an excellent
summary of the current knowledge of cryptorchidism. Some environmental factors
might predispose a patient to cryptorchidism. One of the confounding factors
in many previous studies is the failure to distinguish between primary
maldescent and secondary ascent of the testes. The latter appears to be caused
by failure of elongation of the spermatic cord in proportion to postnatal
growth, leading to apparent undescended testes in older boys. It is recognized
that this secondary event is more likely if there is delayed descent in the
first few weeks after birth. However, it is rare that testes continue to
descend into the scrotum beyond 12 weeks after birth. The difficulty in
determining the precise diagnosis is evident in the table provided by the
authors, with changing apparent incidence in undescended testes at birth over
the last 30 years. In addition, there is a very big difference between the
apparent incidence of cryptorchidism at birth and the frequency of
orchidopexy. The high number of surgeries probably reflects the large
percentage of children with acquired maldescent presenting later in
child-hood. We need a major 10-year follow-up of one of the groups previously
assessed in infancy. The aim of this follow-up should be to determine the
frequency of acquired maldescent in a group of boys who have been examined and
adequately documented at birth. It would be my impression that this is likely
to account for almost half the children undergoing orchidopexy.
The article contains an interesting discussion of the role of environmental
factors on hormonal control of testicular descent, and this highlights our
lack of knowledge about the true effects of these environmental factors.
Obviously, more research is needed to discern the true effect of environmental
factors on hormone levels.
Finally, the increasing frequency of testicular cancer raises many issues
for treatment of undescended testes. Not the least important is whether
treatment can prevent cancer by preventing secondary testicular degeneration
related to high temperature. Although there is good evidence for this effect
in animal experiments, it is not yet known whether very early treatment will
prevent subsequent infertility and cancer in humans.
