Orchidopexy - Surgical Treatments of Male infertility

An undescended testis occurs in 0.8% of male infants at 1 year of age. Spontaneous descent into the scrotum is unlikely after 1 year. Although the most important reason for orchidopexy is to make testicles with a higher risk of cancer palpable, preservation of fertility is another, more debatable reason. Histologic studies of undescended testis show that significant decreases in spermatogonial numbers occur between birth and 2 years of age. Orchidopexy has been recommended within 2 years of age with the idea that some of this germ cell degeneration might be prevented, although proof of this is lacking. Given that sperm can be retrieved from even the smallest failing testis and used for biologic pregnancies, orchidopexy and not orchiectomy should be the primary goal in these cases.

Torsion of the testis is a urologic emergency. There are significant data from animal (but not human) studies to suggest that the unaffected, contralateral testis can become infertile after torsion of its mate. This has been termed sympathetic orchidopathia and is assumed to be immunologic in nature. It is the basis for the recommendation that the nonviable torsed testicle be removed at diagnosis. However, given the advances in assisted reproductive technologies, such recommendations should be reconsidered.

Pituitary Ablation

Elevated serum prolactin levels stemming from a pituitary adenoma can be treated medically and surgically. If the adenoma is radiologically visible (macroadenoma), then transphenoidal surgical ablation of the lesion is possible. If the adenoma is not visible (microadenoma), then medical therapy with the dopamine agonist bromocriptine or a derivative is indicated.

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