Kojima Yoshiyuki, Hayashi Yutaro, Mizuno Kentaro, Kurokawa Satoshi, Nakane Akihiro, Maruyama Tetsuji, Sasaki Shoichi, Kohri Kenjiro
Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences.
Hinyokika Kiyo. 2007 Jul;53(7):517-22.
Orchiopexy is one of the most frequently used surgical procedures for cryptorchidism and has been shown to have a beneficial effect on fertility. However, orchiopexy, especially for bilateral cryptorchidism, does not always guarantee subsequent fertility and paternity. Compared with a control group, paternity was significantly compromised in men with previous bilateral, but not unilateral cryptorchidism. Recent techniques of assisted reproductive technology, especially testicular sperm extraction with intracytoplasmic sperm injection (TESE-ICSI), have brought revolutionary changes in clinical therapy for infertiliy. If spermatozoa exists in testis of infertile men, logically there is a possibility of paternity. However, our study demonstrated that about 20% of pubertal boys who had had orchiopexy, were predicted to have lost their future paternity potential even if TESE-ICSI were conducted, because they were predicted to have no spermatozoa in the testis. To prevent or reverse the damage of spermatogenesis at prepuberty or puberty, we should not take a wait-and-see attitude but should consider a countermeasure for the pubertal boys who had had bilateral orchiopexy in childhood, especially when the serum follicle stimulating hormone level is elevated and testicular volume is lowered, before paternity is lost. In this review, we discuss the potential approaches including epidermal growth facter therapy, gene therapy and stem-cell therapy for cryptorchid patients in the future.
睾丸固定术是治疗隐睾症最常用的外科手术之一，已被证明对生育能力有有益影响。然而，睾丸固定术，尤其是双侧隐睾症的手术，并不总能保证随后的生育能力和亲子关系。与对照组相比，既往患有双侧而非单侧隐睾症的男性，其亲子关系受到显著损害。辅助生殖技术的最新进展，尤其是睾丸精子提取联合卵胞浆内单精子注射（TESE-ICSI），给不育症的临床治疗带来了革命性变化。如果不育男性的睾丸中存在精子，理论上就有生育的可能性。然而，我们的研究表明，约20%接受过睾丸固定术的青春期男孩，即使进行TESE-ICSI，预计也会失去未来的生育潜力，因为预计他们的睾丸中没有精子。为了预防或扭转青春期前或青春期精子发生的损伤，我们不应采取观望态度，而应考虑对童年时接受过双侧睾丸固定术的青春期男孩采取对策，尤其是在血清促卵泡生成素水平升高且睾丸体积缩小、生育能力丧失之前。在这篇综述中，我们讨论了未来针对隐睾患者的潜在治疗方法，包括表皮生长因子治疗、基因治疗和干细胞治疗。
