Hormontherapie bei Hodenhochstand

Zusammenfassung

Der Hodenhochstand stellt eine sehr häufige angeborene Normvariante des Urogenitaltrakts dar. Dabei ist bekannt, dass infolge der Fehllage des Hodens seine normale Entwicklung eingeschränkt sein kann. Eine Folge daraus ist ein erhöhtes Entartungsrisiko sowie eine verminderte Spermiogenese und Fertilität. Zwischen den verschiedenen Fachrichtungen besteht internationaler Konsens darüber, dass die Behandlung des maldeszendierten Hodens spätestens zum ersten Geburtstag abgeschlossen sein sollte. Gemäß der deutschen AWMF-Leitlinie soll die hormonelle Therapie Patienten mit beidseitigem Hodenhochstand angeboten werden. Der nachfolgende Artikel wird die Rationale hinter dieser Empfehlung unter Einbezug der aktuellen Literatur erörtern.

Abstract

Undescended testes are a very common congenital problem of the urogenital tract. Altered spermatogenesis and fertility as well as an elevated risk for oncologic degeneration are known facts associated with testicular malposition. There is broad international consensus among the various disciplines that the treatment of undescended testes should be completed by the age of 12 months. Following the guideline of the German Working Group of Scientific Medical Societies (AWMF), hormonal treatment should be offered to patients with bilateral undescended testicles. This article reviews the literature and disputes the reasoning of the recommendation to treat undescended testes hormonally.

Schlüsselwörter

Kryptorchismus - Hormontherapie - Minipubertät - Fertilität - Maldeszensus testis

Keywords

hormonal treatment - fertility - undescended testes - cryptorchidism - mini-puberty

• Literatur

• 1 Virtanen HE, Cortes D, Rajpert-De Meyts E. et al. Development and descent of the testis in relation to cryptorchidism. Acta Paediatr 2007; 96: 622
• 2 Hadziselimović F, Geneto R, Emmons LR. Elevated placental estradiol: a possible etiological factor of human cryptorchidism. J Urol 2000; 164: 1694
• 3 Yamanaka J, Baker M, Metcalfe S. et al. Serum levels of Mullerian inhibiting substance in boys with cryptorchidism. J Pediatr Surg 1991; 26: 621)
• 4 Barteczko KJ, Jacob MI. The testicular descent in human. Adv. Anat., Embryol. Cell Biol 2000; 156: 1-98
• 5 Rokitansky A. Chirurgische Therapie des Hodenhochstands. Monatsschrift Kinderheilkd 2005; 153: 444-450
• 6 Nef S, Parada LF. Cryptorchidism in m ice mutant for INSL3. Nat. Genet 1999; 22: 295-299
• 7 Cortes D, Thorup J, Visfeldt J. Cryptorchidism: Aspects of Fertility and Neoplasms: A Study IncludingData of 1,335 Consecutive Boys Who Underwent Testicular Biopsy Simultaneously with Surgery for Cryptorchidism. Horm Res 2001; 55: 21-27
• 8 Stec A, Thomas J, DeMarco R. et al. Incidence of testicular ascent in boys with retractiletestes. J Urol 2007; 178: 1722-1724
• 9 Berkowitz GS, Lapinski RH, Dolgin SE. et al. Prevalence and natural history of cryptorchidism. Pediatrics 1993; 92: 44
• 10 Wenzler DL, Bloom DA, Park JM. What is the rate of spontaneous testicular descent in infants with cryptorchidism?. J Urol 2004; 171: 849
• 11 Ritzen EM. Undescended testes: a consensus on management. Eur J Endocrinol 2008; 159 (Suppl. 01) 87-90
• 12 Ritzén EM, Bergh A, Bjerknes R. et al. Nordic consensus on treatment of undescended testes. Acta Paediatr 2007; 96: 638-643
• 13 Waldschmidt J, Doede T, Vygen I. The results of 9 years of experience with a combined treatment with LH-RH and HCG for cryptorchidism. Eur J Pediatr 1993; 152 (Suppl. 02) 34-36
• 14 Dunkel L, Taskinen S, Hovatta O. et al. Germ cell apoptosis after treatment of cryptorchidism with human chorionic gonadotropin is associated with impaired reproductive function in the adult. J Clin Invest 1997; 100: 2341-234
• 15 Cortes D, Thorup J, Visfeldt J. Hormonal treatment may harm the germ cells in 1 to 3-year-old boys withcryptorchidism. J Urol 2000; 163: 1290-1292
• 16 Hadziselimovic F, Zivkovic D, Bica DT. et al. The importance of mini-puberty for fertility in cryptrochidism. J Urol 2005; 174: 1536-1539 ; discussion 1538-1539
• 17 Penson D, Krishnaswami S, Jules A. et al. Effectiveness of hormonal and surgical therapies for cryptorchidism: a systematic review. Pediatrics 2013; 131: e1897-e1907
• 18 Pirgon O, Atabek M, Oran B. et al. Treatment with human chorionic gonadotropin induces left ventricular mass in cryptorchid boys. J Pediatr Endocrinol Metab 2009; 22: 449-454
• 19 Hadziselimovic F, Herzog B. The importance of both an early orchidopexy and germ cell maturation for fertility. Lancet 2001; 358: 1156-1157
• 20 Hadziselimovic F, Zivkovic D, Bica DT. et al. The importance of mini-puberty for fertility in cryptorchidism. J Urol 2005; 174: 1536-1539
• 21 Hadziselimovic F, Hoecht B, Herzog B. et al. Infertility in cryptorchidism is linked to the stage of germ cell development at orchidopexy. Horm Res 2007; 68: 46-52
• 22 Huff DS, Hadziselimovic F, Snyder 3rd HM. et al. Histologic maldevelopment of unilaterally cryptorchid testes and their descended partners. Eur J Pediatr 1993; 152: 11-14
• 23 Schwentner C, Oswald J, Kreczy A. et al. Neoadjuvant gonadotropin-releasing hormone therapy before surgery may improve the fertility index in undescended testes: a prospective randomized trial. J Urol 2005; 173: 974-977
• 24 Lee PA, O'Leary LA, Songer NJ. et al. Paternity after cryptorchidism: lack of correlation with age at orchidopexy. Br J Urol 1995; 75: 704-707
• 25 Schneuer FJ, Milne E, Jamieson SE. et al. Association between male genital anomalies and adult male reproductive disorders: a population-based data linkage study spanning more than 40 years. Lancet Child Adolesc Health 2018; 2: 736-743
• 26 Job JC, Toublanc JE, Chaussain JL. et al. The pituitary-gonadal axis in cryptorchid infants and children. Eur J Pediatr 1987; 146 (Suppl. 02) 2-5
• 27 Hamza AF, Elrahim M, Elnagar O. et al. Testicular descent: when to interfere?. Eur J Pediatr Surg 2001; 11: 173-176
• 28 Verkauskas G, Malcius D, Eidukaite A. et al. Prospective study of histological and endocrine parameters of gonadal function in boys with cryptorchidism. J Pediatr Urol 2016; 12: 238
• 29 Hadziselimovic F, Girard J, Herzog B. 4 yearsʼ experience with combined hormonal treatment of cryptorchism. Z Kinderchir 1984; 39: 324-327
• 30 Hadziselimovic F. Is hormonal treatment of congenital undescended testes justified? . A Debate Sex. Dev. 2019; ; Epub 2019 Jan26. Review
• 31 Vincel B, Verkauskas G, Bilius V. et al. Genoadotropin-Releasing Hormone Agonist corrects defective mini-puberty in boys with cryptorchidism: A prospective randomized study. Biomed Res Int 2018; ; eCollection 2018
• 32 Gegenschatz-Schmid K, Verkauskas G, Stadler MB. et al. Genes located in Y-chromosomal regions important for male fertility show altered transcript levels in cryptorchidism and respond to curative hormone treatment. Basic Clin Androl 2019; 29: 8 eCollection 2019
• 33 Promm M, Schröder A, Neissner C. et al. Acquired cryptorchidism: More harm than thought?. J Pediatr Urol 2016; 12: 236.e1-6 ; Epub 2016 May 27