Zusammenfassung
Hodenhochstand ist die häufigste genitale Fehlbildung bei Jungen. Frühgeborene Jungen sind bis zu einem Drittel vom Maldescensus testis betroffen, bei termingerecht geborenen Knaben leiden etwa 2–5% an mindestens einem nicht deszendierten Hoden.
Infolge einer kurzfristigen endogenen Testosteronsekretion nach der Geburt reduziert sich die Inzidenz nach 3 Monaten auf 1–2%. Eine abwartende Haltung („watchful waiting“) nach 6 Monaten ist nach der Studienlage nicht indiziert, da es hiernach nur sehr selten zu einem spontanen Deszensus kommt. Obwohl die Auswirkung des Hodenhochstands auf die testikuläre Entwicklung und Fertilität umfassend untersucht worden ist, bleibt als einzige Tatsache die Gewissheit, dass unbehandelte Männer mit einem bilateralen Hodenhochstand in ca. 90% der Fälle eine Azoospermie entwickeln. Die übrigen Szenarien des Hodenhochstands (unilateral, ektop, inguinal, Gleithoden, behandelt oder nicht behandelt) weisen eine unvorhersagbare Fertilität und Wahrscheinlichkeit einer Vaterschaft aus.
Abstract
Cryptorchidism is the most common genital disorder in boys. Early-born boys are affected in up to one third of the cases, while about 2–5% of full-term newborns suffer from at least one undescended testicle.
As a result of short-term endogenous testosterone secretion after birth the prevalence decreases to 1–2% after 3 months. According to most studies, watchful waiting after 6 months is not justified because after this time spontaneous testicular descent only very rarely occurs. Even though the effects of testicular development and fertility in undescended testis have been extensively examined, the only fact that remains certain is that approximately 90% of untreated men with bilateral cryptorchidism develop azoospermia. The remaining scenarios of cryptorchidism (unilateral, ectopic, inguinal, treated or not treated) exhibit unpredictable fertility and likelihood of fatherhood.
Literatur
Toppari J, Kaleva M (1999) Maldescensus testis. Horm Res 51:261–269
Docimo S, Silver RI, Crome W (2000) The undescended testicle: diagnosis and treatment. Am Fam Physician 62(9):2037–20448
Berkowitz GS, Lapinski RH, Dolgin SE et al (1993) Prevalence and natural history of cryptorchidism. Pediatrics 92:44–49
Hadziselimovic F (2002) Cryptorchidism: its impact on male fertility. Eur Urol 41:121–123
Cortes D, Thorup JM, Visfeldt J (2001) Cryptorchidism: aspects of fertility and neoplasms. Horm Res 55:21–27
Wikerson ML, Bartone FF, Fox L et al (2001) Fertility potential: a comparison of intra-abdominal and intracanalicular testes by age groups in children. Horm Res 55:18–29
Lee PA, Coughlin MT, Bellinger MF (2000) Paternity and hormone levels after unilateral cryptorchidism: relationship to pre-treatment testicular location. J Urol 164:1697–1700
Hadziselimovic F, Herzog B (2001) Importance of early postnatal germ cell maturation for fertility of cryptorchid males. Horm Res 55:6–10
Cortes D, Thorup JM, Visfeldt J (2001) Cryptorchidism: aspects of fertility and neoplasms. A study including data of 1335 consecutive boys who underwent testicular biopsy simultaneously with surgery for cryptorchidism. Horm Res 55:21–27
Hadziselimovic F, Höcht B, Herzog B, Buser MW (2007) Infertility in cryptorchidism is linked to the stage of germ cell development at orchidopexy. Horm Res 68:46–52
Hadziselimovic F, Hoecht B (2008) Testicular histology related to fertility outcome and postpubertal hormone status in cryptorchidism. Klin Padiatr 220:302–307
Leitlinie der Deutschen Gesellschaft für Kinderchirurgie, der Deutschen Gesellschaft für Urologie und der Deutschen Gesellschaft für Kinder- und Jugendmedizin, vertreten durch die Arbeitsgemeinschaft für pädiatrische Endokrinologie (APE) (2008) Hodenhochstand – Maldeszensus testis. http://www.uni-duesseldorf.de/AWMF/ll/006-022.htm
Engeler DS, Hosli PO, Hubert J et al (2000) Early orchiopexy: prepubertal intratubular germ cell neoplasia and fertility outcome. Urology 56:144–148
Chilvers C, Dudley NE, Gough MH et al (1986) Undescended testis: the effect of treatment on subsequent risk of subfertility and malignancy. J Pediatr Surg 21:691–696
Lee PA, Coughlin MT (2001) Fertility after bilateral cryptorchidism. Evaluation by paternity, hormone, and semen data. Horm Res 55:28–32
Hadziselimovic F, Herzog B (1997) Treatment with a luteinizing hormone-releasing hormone analogue after successful orchiopexy markedly improves the chance of fertility later in life. J Urol 158(3 Pt 2):1193–1195
Cortes D, Thorup J, Visfeldt J (2000) Hormonal treatment may harm the germ cells in 1 to 3-year-old boys with cryptorchidism. J Urol 163:1290–1292
Dunkel L, Taskinen S, Hovatta O et al (1997) Germ cell apoptosis after treatment of cryptorchidism with human chorionic gonadotropin is associated with impaired reproductive function in the adult. J Clin Invest 100(9):2341–2346
Huff DS, Hadziselimovic F, Snyder HM III et al (1989) Postnatal testicular maldevelopment in unilateral cryptorchidism. J Urol 142:546–548
Ong C, Hasthorpe S, Hutson JM (2005) Germ cell development in the descended and cryptorchid testis and the effects of hormonal manipulation. Pediatr Surg Int 21:240–254
Schleef JV, Bismarck S, Burmucic K et al (2002) Groin exploration for nonpalpable testes: laparoscopic approach. J Pediatr Surg 11:1552–1555
Hadziselimovic F, Herzog B (1976) The meaning of the Leydig cell in relation to the etiology of cryptorchidism: an experimental electron-microscopic study. J Pediatr Surg 11:1–8
James WH (1993) The incidence of superfecundation and of double paternity in the general population. Acta Genet Med Gemellol 42:257–262
Lee PA, O’Leary LA, Songer NJ et al (1996) Paternity after unilateral cryptorchidism. Pediatrics 98:676–679
Mathers MJ, Sperling H, Rübben H, Roth S (2009) The undescended testis: diagnosis, treatment and long-term consequences. Dtsch Arztebl Int 106(33):527–532
Dickerman Z, Bauman B, Sandovsky U et al (1983) HCG treatment in cyptorchidism. Andrologia 16:542
Lala R, Matarazzo P, Chiabotto P et al (1993) Combined therapy with LHRH and HCG in cyptorchid infants. Eur J Pediatr 152:31
Rajfer J, Handelsman DJ, Swertloff RS et al (1986) Hormonal therapy of cryptorchidism. N Engl J Med 314:466
Schwentner C, Oswald J, Kreczy A et al (2005) Neoadjuvant gonadotropin-releasing hormone therapy before surgery may improve the fertility index in undescended testes: a prospective randomized trial. J Urol 173(3):974–977
Pyörälä S, Huttumen NP, Uhari M (1995) A review and meta-analysis of hormonal treatment of cryptorchidism. J Clin Endocrinol Metab 80:2795–2799
Ritzen EM, Bergh A, Bjerknes R et al (2007) Nordic consensus on treatment of undescended testes. Acta Paediatr 96(5):638–643
Baker LA, Docimo SG, Surer I et al (2001) A multi-institutional analysis of laparoscopic orchidopexy. BJU Int 87:484–489
Strittmatter T (2001) Testicular autotransplantation – the mönchengladbach experience. Horm Res 55:52
Rose A, Sperling H, Steffens J et al. (2006) Multimodale Therapie des Maldeszensus testis. Urologe 45:214–218
Schleef JV, Bismarck S, Burmucic K et al (2002) Groin exploration for nonpalpable testes: laparoscopic approach. J Pediatr Surg 11:1552–1555
Williams EV, Appanna T, Foster ME (2001) Management of the impalpable testis: a six year review together with a national experience. Postgrad Med J 77:320–322
Docimo SG (1995) The results of surgical therapy for cryptorchidism: a literature review and analysis. J Urol 154:1148–1152
Fowler R, Stephens FD (1959) The role of testicular vascular anatomy in the salvage of high undescended testes. Aust N Z J Surg 29:92–106
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Mathers, M., Degener, S. & Roth, S. Hodenhochstand und Infertilität unter besonderer Berücksichtigung der interdisziplinären Leitlinie. Urologe 50, 20–25 (2011). https://doi.org/10.1007/s00120-010-2438-x
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DOI: https://doi.org/10.1007/s00120-010-2438-x