Muncey Wade, Dutta Rahul, Terlecki Ryan P, Woo Lynn L, Scarberry Kyle
Case Western Reserve University School of Medicine, Cleveland, OH, USA.
University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Andrology. 2021 May;9(3):781-791. doi: 10.1111/andr.12964. Epub 2021 Jan 8.
Reports of adult orchidopexy for bilateral undescended testicles (bUDT) are sparse, and fertility outcomes are not well established. Our aim was to determine prognosis for restoration of spermatogenesis among adult men (≥18 years) undergoing orchidopexy for bUDT.
A systematic literature review, conforming to the PRISMA statement, was conducted using the PubMed/MEDLINE and EMBASE databases through March 2020 using search terms "adult" AND "bilateral orchidopexy" OR "bilateral cryptorchidism." Relevant referenced articles from non-indexed journal were identified by Google Scholar search and additionally included.
Fifty-seven publications including adult men with uncorrected bilateral UDTs were identified. Baseline semen analysis was reported in 157 men, all of whom demonstrated azoospermia. Testosterone values were reported in 82 cases and were normal in 89%. Germ cells could not be identified in 72.6% of histologic specimens from 62 testicles. Abdominal testicles more frequently lacked germ cells (90%, p = 0.038) on univariate analysis. Eleven cases identified ejaculated spermatozoa following adult bilateral orchidopexy (8 publications). Sperm extraction (TESE) during orchidopexy or orchiectomy was reported in 13 men without success. Delayed TESE (median 10 months) was performed in 22 persistently azoospermic men with success in 10 (45.5%), none of whom had abdominal testicles prior to orchidopexy. Six men experienced successful paternity via natural conception (3) or assisted reproduction (3).
Fertility is possible in adult men with inguinal bUDT following orchidopexy. Subsequent sperm retrieval may involve ejaculated specimens or delayed TESE. TESE performed prior to or at time of orchidopexy is unlikely to be of benefit.
关于双侧隐睾（bUDT）的成人睾丸固定术的报道较少，且生育结局尚未明确。我们的目的是确定接受bUDT睾丸固定术的成年男性（≥18岁）精子发生恢复的预后情况。
按照PRISMA声明进行系统的文献综述，截至2020年3月，使用PubMed/MEDLINE和EMBASE数据库，搜索词为“成人”和“双侧睾丸固定术”或“双侧隐睾症”。通过谷歌学术搜索识别并额外纳入非索引期刊中的相关参考文献。
共识别出57篇包含未矫正双侧UDT成年男性的出版物。157名男性报告了基线精液分析，所有这些男性均表现为无精子症。82例报告了睾酮值，其中89%正常。在来自62个睾丸的组织学标本中，72.6%未发现生殖细胞。单因素分析显示，腹腔内睾丸更常缺乏生殖细胞（90%，p = 0.038）。11例在成人双侧睾丸固定术后发现射出精子（8篇出版物）。13名男性在睾丸固定术或睾丸切除术中进行了精子提取（TESE），但未成功。22名持续无精子症男性进行了延迟TESE（中位时间10个月），10名成功（45.5%），其中在睾丸固定术前均无腹腔内睾丸。6名男性通过自然受孕（3例）或辅助生殖（3例）成功生育。
腹股沟型bUDT成年男性在睾丸固定术后有可能生育。后续的精子获取可能涉及射出标本或延迟TESE。在睾丸固定术之前或同时进行TESE不太可能有益。
