Friedman R M, López F J, Tucker J A, King L R, Negro-Vilar A
Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina 27710.
J Urol. 1994 Jan;151(1):227-33. doi: 10.1016/s0022-5347(17)34922-4.
Infertility is common in patients with a history of bilateral cryptorchidism, even after successful prepubertal orchidopexy. Recent data suggest that this defect may be partially due to the existence of hormonal abnormalities in some forms of cryptorchidism. To analyze any potential benefit of hormonal therapy, we have evaluated the immediate and long-term effects of chronic hormonal therapy administered following surgical correction of cryptorchidism. First, using young male rats, we examined the effects of chronic human chorionic gonadotropin (HCG) and a luteinizing hormone-releasing hormone agonist (LHRH-A), alone or combined, on acute pituitary-gonadal axis responsiveness to LHRH administration. High doses of HCG and/or LHRH-A induced deleterious effects on the pituitary-testicular axis in terms of suppression of response to LHRH. Therefore, treatment with a low dose of HCG (50 U/kg/day) for 14 days was used, since it produced a significant increase in intratesticular testosterone (ITT). Second, we tested this hormonal regimen in a cryptorchid rat model. Bilateral cryptorchidism was produced by gubernaculum resection at 14 days of age. Early orchidopexy was performed at age 30 days, and HCG therapy was given from 31 to 44 days of age. Follicle stimulating hormone (FSH), luteinizing hormone (LH) and testosterone (T) levels were determined before and immediately after hormonal therapy, and at sacrifice. Animals were sacrificed at 61 days of age for determination of serum and testicular hormone levels, accessory sex organ weights and testis histology. Five or six animals from each group were retained for breeding studies at the age of 90 days. Hormonal alterations noted immediately following treatment of cryptorchid animals with HCG are not lasting. The data reveal that the fertility defect in bilateral cryptorchidism is partially prevented by early orchidopexy and that adjunctive hormonal therapy is probably of little additional benefit.
不育在有双侧隐睾病史的患者中很常见，即使在青春期前睾丸固定术成功之后也是如此。最近的数据表明，这种缺陷可能部分归因于某些形式的隐睾症中存在激素异常。为了分析激素治疗的任何潜在益处，我们评估了在隐睾症手术矫正后给予慢性激素治疗的即时和长期效果。首先，我们使用年轻雄性大鼠，研究了单独或联合使用慢性人绒毛膜促性腺激素（HCG）和促黄体生成素释放激素激动剂（LHRH-A）对垂体-性腺轴对LHRH给药的急性反应性的影响。高剂量的HCG和/或LHRH-A在抑制对LHRH的反应方面对垂体-睾丸轴产生了有害影响。因此，采用低剂量的HCG（50 U/kg/天）治疗14天，因为它使睾丸内睾酮（ITT）显著增加。其次，我们在隐睾大鼠模型中测试了这种激素方案。在14日龄时通过切除睾丸引带制造双侧隐睾症。在30日龄时进行早期睾丸固定术，并在31至44日龄时给予HCG治疗。在激素治疗前、治疗后即刻以及处死时测定促卵泡生成素（FSH）、促黄体生成素（LH）和睾酮（T）水平。在61日龄时处死动物，以测定血清和睾丸激素水平、附属生殖器官重量和睾丸组织学。每组保留五或六只动物在90日龄时进行繁殖研究。用HCG治疗隐睾动物后立即出现的激素改变并不持久。数据显示，早期睾丸固定术可部分预防双侧隐睾症的生育缺陷，辅助激素治疗可能几乎没有额外益处。
