Primary gonadotropin releasing hormone and adjunctive human chorionic gonadotropin treatment in cryptorchidism: a clinical trial.

OBJECTIVES: The effect of intranasal gonadotropin-releasing hormone (GnRH) and intramuscular human chorionic gonadotropin (hCG) in the treatment of cryptorchidism was investigated in 48 prepubertal boys. METHODS: Forty-eight prepubertal boys with 70 undescended testes were enrolled into a prospective study between November 1989 and November 1991. GnRH was applied as nasal spray at a dose of 1.2 mg/day for 4 weeks. The patients with partial descent were subsequently treated with 1500 IU hCG weekly for 3 weeks. RESULTS: Complete descent was observed in 53% (37 of 70) of testes; 58% (15 of 26) in unilateral and 50% (22 of 44) in bilateral undescended testes. One abdominally located testicle did not respond to therapy. Of 37 testes located in the inguinal canal, seven (19%) descended. On the other hand, descensus rates were 100% for the testes located at the external inguinal ring and at a high scrotal level. Six primarily descended testes (16%) showed relapse during the follow-up. Surgery was performed in 12 patients (14 testes), revealing associated hernia in nine testes and epididymal anomalies in four. CONCLUSIONS: We believe that the GnRH and hCG combination is an effective therapy for undescended testes located at and beyond the external inguinal ring and should be the first treatment choice because of its noninvasiveness. Both unilateral and bilateral undescended testes responded with similar success rate to hormonal therapy. Surgery should be considered for proximal cryptorchidism.