Department of Paediatric Urology, Southampton General Hospital, Division of Women and Children, Care Group - Child Health MP43, G Level East Wing, Tremona Road, Southampton, Hampshire SO16 6YD, UK.
J Pediatr Urol. 2010 Jun;6(3):239-46. doi: 10.1016/j.jpurol.2010.02.203. Epub 2010 Mar 23.
Male fertility depends on the transformation of gonocytes into dark adult spermatogonia, during the first 3 months of postnatal life, and this is an androgen-dependent process. This essential developmental step appears to be defective in undescended testes, and in many patients orchidopexy alone (at the age it is currently performed) does not improve fertility indices, either because it does not address the underlying pathophysiology or the surgery is performed too late. Hormone therapy with gonadotrophin-releasing hormone creates a rise in testosterone levels, copying the postnatal gonadotrophin surge. This can improve germ cell numbers, with the implication of enhanced longer-term fertility. The role of hormone therapy has been controversial, and although favoured at the European Society of Paediatric Urologists' workshops in 2008 and 2009, it is not routine clinical practice in the UK or other countries. We performed a critical appraisal of the key papers in the world literature to evaluate the level of evidence for improved fertility indices, semen analysis and paternity rates following hormone therapy in undescended testes. We suggest that the evidence is sufficiently strong to recommend a change in clinical practice.
男性生育能力取决于精原细胞在出生后 3 个月内转化为暗的成年精原细胞，这是一个雄激素依赖的过程。这个重要的发育步骤似乎在未下降的睾丸中存在缺陷，并且在许多患者中，单纯的睾丸固定术（目前进行的年龄）并不能改善生育指数，要么是因为它没有解决潜在的病理生理学问题，要么是因为手术太晚了。用促性腺激素释放激素进行激素治疗会导致睾酮水平升高，复制出生后的促性腺激素激增。这可以增加生殖细胞的数量，从而提高长期生育能力。激素治疗的作用一直存在争议，尽管在 2008 年和 2009 年欧洲小儿泌尿科医师协会的研讨会上受到青睐，但在英国或其他国家并非常规临床实践。我们对世界文献中的关键论文进行了批判性评估，以评估激素治疗未下降的睾丸后改善生育指数、精液分析和亲权率的证据水平。我们认为，证据足够有力，建议改变临床实践。
