Cryptorchidism
Terry D. Allen MD1
1 Division of Urology, The University of Texas Health Science Center, Dallas, TX 75235
Recent developments, particularly in the field of endocrinology, have substantially altered many conventional concepts about descended testis. The disease can no longer be viewed solely as a mechanical problem in descent, and there is an increasingly greater emphasis being placed upon the early resolution of the disorder in an effort to maximize ultimate testicular function. In this brief review, some of the controversies and current philosophies regarding this subject are explored.
THE ENDOCRINOLOGIC QUESTION
Although etiologic considerations in cryptorchidism have always included the possibility of inadequate hormonal stimulation, this concept has generally been overshadowed by one that emphasizes mechanical impediment to descent. This viewpoint seemed justified by the fact that endocrine therapy had never yielded more than modest results and by the feeling that it was difficult to account for unilateral cryptorchidism on the basis of a generalized endocrinopathy. After all, "if inadequate hormonal stimulation were the cause of maldescent of one testis, why did the other one descend?" The recent work of Job and associates in Paris, however, has shattered many of these arguments with the revelation that endocrine abnormalities can indeed be identified in patients with cryptorchidism and that furthermore these abnormalities canbe identified in patients with unilateral cryptorchidism as well as in those with bilateral disease.
