İnmemiş Testisli Çocuklarda Hormon Tedavisi. Prospektif Klinik Çalışma.

AMAÇ: İnmemiş testisli çocuklarda hCG tedavisinin testis inişine ve hacmine, penis boyuna, serum antisperm antikor (ASA), folikül stimulan hormon (FSH), luteinizan hormon (LH) ve total testosteron düzeylerine olan etkisini araştırmak. GEREÇ VE YÖNTEM: Etik kurul onayı sonrasında çalışmaya inmemiş testis tanısı almış 46 prepubertal olgu dahil edildi. Hastalar Plasebo (n=17) ve Pregnyl (n=29) olmak üzere iki gruba ayrıldı. Pregnyl grubundan 6 olguda (%20,6) hCG tedavisi sonrasında testis inişi oldu ve bu olgular çalışmadan çıkarıldı (n=23). Birinci gruptakilere (Plasebo) 3 hafta boyunca, haftada bir kez olmak üzere im SF uygulandı. İkinci gruptakiler (Pregnyl) 3 hafta boyunca, haftada bir kez olmak üzere 100 IU/kg im hCG ile tedavi edildiler. Olguların tedavi öncesinde ve orşiopeksiden 1 ay sonra ultrasonografi ile testis boyutları ve yerleşimleri değerlendirildi, penis boyları, serum ASA, FSH, LH ve total testosteron düzeyleri ölçüldü. BULGULAR: Penis boyu, testis hacmi ve serum total testosteron düzeyi hCG tedavisi alan grupta (Pregnyl), SF tedavisi alan gruba (Plasebo) göre anlamlı düzeyde arttı (p

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  • Umakanth A, Khatwa and P.S.N. Menon. Management
  • of Undescended Testis. Ýndian J Pediatr 2000; 67 (6): 449.
  • Rajfer J. Surgical and hormonal therapy for cryptorchidism: An Overview. Horm Res 1998; 30: 139.
  • Berkowitz GS, Lapinski RH, Dolgin SE, Gazella JG, Bodian CA, Holzman IR. Prevalance and natural history of cryptorchidism. Pediatrics 1993; 92: 44.
  • Hjertkvist M, Dauber JE, Bergh A. Cryptorchidism: A registry-based study in Sweden on some factors of some possible etiological importance. J Epidemiol Community Health 1989; 146: 324.
  • Y. Kubota, S. Nef, P. Farmer, C. Temelcos, L. Parada, J. Hutson. Leydig insulin-like hormone, gubernacular development and testicular descent. J Urol 2001; 165: 1673.
  • Gill B. Kogan S. Crytorchidism: Current consept. Pediatr Clin North Am 1997; 44: 1211.
  • Elder JS. The Undescended Testis: Hormonal and surgical management. Surg Clin North Am 1988; 68: 983.
  • Miller OF, Stock JA, Cilento BG, McAleer IM, Kaplan GW.Prospective evaluation of human chorionic gonadotropin in the differentiation of undescended testes from retractile testes. J Urol 2003; 169: 2328.
  • Bukowski TP, Sedberry S and Richardson B. Is human chorionic gonadotropin useful for identifying and treating nonpalpable testis? J Urol 2001; 165: 221.
  • MacKinnon AE. The undescended testis. Indian J Pediatr 2005; 72: 429.
  • Kapur DK, Ahuja GK. Immunocytochemistry of male reproductive organs. Arch Androl 1989; 23(3): 169.
  • Leung WY, Poon M, Fan TW, Siu KW, Chung KW, Kwok WK, Kwok CH. Testicular volume of boys after inguinal herniotomy: combined clinical and radiological follow-up. Pediatr Surg Int 1999; 15(1): 40-1.
  • Canavese F, Cortese MG, Magro P, Lonati L, Teruzzi E, de Sanctis C, et al. Cryptorchidism: medical and surgical treatment in the 1st year of life. Pediatr Surg Int 1998; 14: 2.
  • Lala R, Matarazzo P, Chiabotto P, Gennari F, Cortese MG, Canavese F, et al. Early hormonal and surgical treatment of cryptorchidism. J Urol 1997; 157: 1898.
  • Grasso M, Buonaguidi A, Lania C, Bergamaschi F, Castelli M, Rigatti P. Postpubertal cryptorchidism: Review and evaluation of the fertility. Eur Urol 1991; 20: 126.
  • Mininberg DT, Rodger JC, Bedford JM. Ultrastructural evidence of the onset of testicular pathological conditions in the cryptorchid human testis ithin the first year of life. J Urol 1982; 128: 782.
  • Hadziselimoviç, F: Hormonal treatment In: Hadziselimoviç MD (Ed): Cryptorchidism: Management and Implications. Berlin: Springer Verlag 1983; 101-14.
  • Rajfer J, Handelsman DJ, Swerdloff RS, Hurwitz R, Kaplan H, Vandergast T. Hormonal therapy of cryptorchidism: a randomized, double-blind study comparing human chorionic gonadotropin and gonadotropin-releasing hormone N Engl J Med 1986; 314: 466.19
  • Ünal D, Yeni E, Verit A, Çiftçi H. Ýnmemiþ testiste primer human koriyonik gonadotropin tedavisine yanýtý etkileyen faktörler. Türk Üroloji Dergisi 2002; 28(2): 166
  • Fedder J, Boesen M: Effect of a combined GnRH/hCG therapy in boys with ndescended testicles: Evaluated in relation to testicular localization within the first week after birth. Arch Androl 1998; 40: 181.
  • Garagorri JM, Job JC, Canlorbe P. Results in early treatment of cryptorchidism with human chorionic gonadotropin. J Pediatr. 1982; 101: 923.
  • Job JC, Canlorbe P, Garagorri JM, Toublanc JE. Hormonal therapy of cryptorchidism with human chorionic gonadotropin (hCG) Urol Clin N Amer 1982; 9: 405.
  • Cortes D, Thorup J, Visfeldt J, Hormonal treatment may harm the germ cells in 1 to 3- year-old boys with cryptorchdism. J Urol 2000; 162: 1290.
  • Heýskanen P, Býllýg H, Topparý J, Kaleva M, Arsalo A, Rapola J, et al. Appoptotic cell death in the normal and cryptorchid human testis: the effect of human chorionic gonadotropin on testicular cell survival. Pediatr Res 1996; 40: 351.
  • Christiansen P, Müller J, Buhl S, Hansen OR, Hobolth N, Jacobsen BB,et al. Hormonal treatment of cryptorchidism-hCG or GnRH- a multicentre study. Acta Pediatr 1992; 81: 605.
  • Giannopoulos MF, Vlachakis IG, Charissis GC. 13 years’ experience with the combined hormonal therapy of cryptorchidism. Horm Res 2001; 55: 33.
  • Walsh PC, Curry N, Mills RC, Siiteri PK. Plasma androjen response to hCH stimulation in prepubertal boys with hypospadias and cryptorchidism. J Clin Endocrinol Metab 1976; 42: 52.
  • Cacciari E, Gicognani A, Prazzoli P, Zappola F, Tassoni P, Bernardi F, et al. Hypophysogonadal function in the cryptorchid child: differences between unilateral and bilateral cryptorchids. Acta Endocrinol 1976; 83: 182.
  • Gendrel D, Roger M, Job JC. Plasma gonadotropin and testosterone values in infants with cryptorchidism. J Pediatr 1980; 97: 217.
  • Muinck K, Hazebroek FWJ, Drop SLS, Degenhart HJ, Molenaar JC, Visser HKA.
  • Hormonal evaluation of boys with undescended testes during their first year of life. J Clin Endocrinol Metab 1988; 66: 159.
  • Urry RL, Carrell DT, Star NT, Snow BW and Middleton RG. The incidence of antisperm antibodies in infertility patients with a history of cryptorchidism. J Urol 1994; 151: 381.
  • Lenzi A, Gandini L, Lombardo F, Cappa M, Nardini P, Ferro F, Borrelli P, and Dondero F. Antisperm antibodies in young boys. Andrologia 1991; 23: 233.
  • Sinisi AA, Pasquali D, Papparella A, Valente A, Orio F, Esposito D, et al. Antisperm antibodies in cryptorchidism before and after surgery. 1998; 160:1834.