The Most Frequent Histological Findings in the Adult Testis When Testicular Descent Was Performed in Childhood

Abstract

A normal sperm count is the best functional proof that the treatment given to a cryptorchidic patient has been effective. Adults with a history of orchiopexy have lower sperm counts than the general population. Only 28 % of adults with bilateral orchiopexy performed in childhood present at least 20 million/ml in the ejaculate, while in unilateral cryptorchidism, this figure rises up to 70 %. Despite early orchiopexy 32 % of patients with bilateral and 10 % with unilateral cryptorchidism are azoospermic.

In an attempt to improve these results, physicians have started to correct the anatomical abnormality at younger and younger ages, and so the correct time for orchiopexy has been established to be between 6 and 12 months of life in order to prevent the loss of germ cells due to a higher temperature in the undescended testis. This measure has proven to be insufficient because many undescended testes are the result of hypogonadism from fetal life, as can be seen in the little proliferation of germ cells and also in postnatal life coinciding with the mini-puberty due to incomplete transformation of gonocytes in Ad spermatogonia. The Ad spermatogonia are the stem cells, and a low number of these are associated with a deficit of spermatogenesis. This is why it is necessary to add hormonal treatment at the time of orchiopexy in an attempt to increase the amount of germ cells.Testicular biopsy has emerged as the best method to determine the presence, the number, and type of germ cells in childhood and in adulthood to confirm the results of treatment performed in childhood. This chapter refers to lesions of both undescended and contralateral testis of patients consulting for infertility whose testes had been descended, and in most cases, biopsy was performed in early childhood in order to know the predictive value of the lesions observed.