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Aspects cliniques, biologiques et thérapeutiques de la cryptorchidie diagnostiquée à l’âge adulte: analyse d’une série de 69 cas

Clinical, biological and therapeutic features of adult cryptorchidism: about 69 cases

Basic and Clinical Andrology volume 19, pages 168–172 (2009)Cite this article

Résumé

But

Rapporter les aspects cliniques, biologiques et thérapeutiques de la cryptorchidie chez l’adulte et discuter de l’intérêt de l’abaissement du testicule non descendu (TND) chez l’adulte.

Patients et méthodes

Il s’agit d’une étude rétrospective colligeant 69 patients âgés de plus de 18 ans pris en charge au service d’urologie-andrologie du CHU Aristide-Le-Dantec pour cryptorchidie entre janvier 1999 et décembre 2007.

Résultats

L’âge moyen de nos patients était de 31,04 ± 8,4 ans (extrêmes 18 et 55 ans). Les principales circonstances de découverte ont été l’infertilité masculine (38 cas), la vacuité des bourses (21 cas) et la dégénérescence maligne du TND (six cas). La cryptorchidie était unilatérale dans 69,5 % et bilatérale dans 30,4 % des cas. Le spermogramme effectué chez 60 de nos patients a montré une azoospermie dans 46,6 % des cas, une oligozoospermie dans 38,3 % et une numération de spermatozoïdes normale dans 15 % des cas. Tous les patients ayant une cryptorchidie bilatérale avaient une azoospermie. À l’exploration chirurgicale, le TND a été retrouvé dans 95,6 % des cas (66 patients). Le principal type de traitement réalisé a été l’abaissement testiculaire. L’histologie des pièces d’orchidectomie sur testicule non tumoral (n = 7) a trouvé dans tous les cas une atrophie testiculaire sévère avec absence complète de cellules germinales. Les types histologiques des cancers étaient le séminome (n = 3) et le carcinome embryonnaire (n = 3). Parmi les patients ayant une azoospermie (n = 28), aucun cas d’induction de la spermatogenèse après abaissement testiculaire n’a été observé. Parmi les patients ayant consulté pour infertilité masculine, trois d’entre eux ont eu des enfants après abaissement testiculaire, soit un taux de paternité de 7,8 %.

Conclusion

Dans la cryptorchidie de l’adulte, l’abaissement du testicule a peu d’impact sur la fertilité masculine. Mais, vu les progrès actuels de l’assistance médicale à la procréation (AMP), le dogme d’orchidectomie systématique devant un TND diagnostiqué à l’âge adulte doit être reconsidéré.

Abstract

Objective

To report the clinical, biological and therapeutic features of adult cryptorchidism and to determine whether orchidopexy at adulthood may improve male fertility.

Material and methods

We retrospectively studied the clinical pattern, biological and therapeutic features of 69 men aged of more than 18 years admitted for cryptorchidism at the urological department of Aristide-Le-Dantec teaching hospital between January 1999 and December 2007.

Results

The mean age of our patients was 31.04 ± 8.4 years. In the majority of cases, cryptorchidism was diagnosed in a context of infertility (38 cases), scrotum vacancy (21 cases) and testicular cancer (six cases). Cryptorchidism was unilateral in 69.5% and bilateral in 30.4% of cases. Semen analyses were done for 60 patients and showed azoospermia in 46.6%, oligozoospermia in 38.3% and a normal sperm count in 15% of cases. In all bilateral cryptorchidism cases, semen analyses showed azoospermia. At surgery, the undescended testis was found in 66 cases (95.6%) and orchidopexy was the most done surgical procedure. Seven patients (without testicular cancer) underwent unilateral orchiectomy and histology of specimens showed sertoli-cell-only syndrome with no spermatogenesis in all cases. The histological type of testicular cancer was seminoma (three cases) and embryonic carcinoma (three cases). In azoospermic men (28 cases) no induction of spermatogenesis was achieved after orchidopexy. In infertile patients, the improvement of sperm count was seen in three patients with unilateral cryptorchidism. Three patients with unilateral crytorchidism achieved pregnancy (pregnancy rate of 7.8%).

Conclusion

Orchidopexy for adult cryptorcidism had little impact in male fertility. Because of the risk of testicular cancer, orchidectomy was recommended as treatment of unilateral cryptorchidism. But with the recent development of TESE, orchidopexy appears as a reasonable treatment of adult cryptorchidism.

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Authors and Affiliations

  1. Service d’urologie-andrologie, CHU Aristide-Le-Dantec, BP 35354, Dakar Colobane, Sénégal

    B. Fall, P. A. Fall, M. Ali, B. Diao, Y. Sow, F. A. Kaboré, A. Sarr, A. K. Ndoye & B. A. Diagne

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  1. B. Fall
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  2. P. A. Fall
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  3. M. Ali
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  4. B. Diao
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  8. A. K. Ndoye
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  9. B. A. Diagne
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Correspondence to B. Fall.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Fall, B., Fall, P.A., Ali, M. et al. Aspects cliniques, biologiques et thérapeutiques de la cryptorchidie diagnostiquée à l’âge adulte: analyse d’une série de 69 cas. Basic Clin. Androl. 19, 168–172 (2009). https://doi.org/10.1007/s12610-009-0029-8

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Basic and Clinical Andrology

ISSN: 2051-4190