Impact of hormonal and surgical interventions versus surgery alone on fertility potential in undescended testes: A systematic review and meta-analysis.
Fransiskus Rajagukguk, Gerhard Reinaldi Situmorang, Irfan Wahyudi, Arry Rodjani, Putu Angga Risky Raharja
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引用次数: 0
Abstract
Background: The role of hormonal therapy as an adjunct to surgery in managing undescended testes (UDT) remains controversial. Its implications for future fertility are still unclear, and clinical practices vary globally.
Objective: To evaluate the effects of combined hormonal and surgical treatment versus surgery alone on fertility potential in males with UDT.
Study design: A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. Databases searched included PubMed, Scopus, Embase, ClinicalTrials.gov, and Cochrane up to April 14, 2025. Eligible studies were randomized controlled trials and cohort studies comparing combined hormonal and surgical therapy with surgery alone, reporting on fertility-related potentials. Risk of bias was assessed using RoB 2.0 or the Newcastle-Ottawa Scale, and data synthesis was performed using RevMan 5.4.
Results: Nine studies comprising 652 patients were included. Hormonal therapy combined with surgery significantly increased the number of spermatogonia per tubule (mean difference [MD] 0.23; 95 % CI: 0.07 to 0.38; p = 0.003), with more pronounced effects in bilateral UDT (MD 0.35; 95 % CI: 0.17-0.53; p = 0.001). However, no significant improvements were observed in long-term fertility markers, including sperm count, inhibin B, or testosterone. FSH levels were slightly lower in the combined group (MD -0.77 IU/L; 95 % CI: -1.29 to -0.26; p = 0.003).
Conclusion: Adjunctive hormonal therapy may enhance early germ cell maturation, particularly in bilateral UDT. However, current evidence does not demonstrate clear long-term benefits in fertility-related potentials. Future high-quality, biomarker-stratified, and longitudinal studies are essential, and should include direct endpoints such as sperm counts and paternity, to fully determine the clinical utility of pre-orchidopexy hormonal treatment.
期刊介绍:
The Journal of Pediatric Urology publishes submitted research and clinical articles relating to Pediatric Urology which have been accepted after adequate peer review.
It publishes regular articles that have been submitted after invitation, that cover the curriculum of Pediatric Urology, and enable trainee surgeons to attain theoretical competence of the sub-specialty.
It publishes regular reviews of pediatric urological articles appearing in other journals.
It publishes invited review articles by recognised experts on modern or controversial aspects of the sub-specialty.
It enables any affiliated society to advertise society events or information in the journal without charge and will publish abstracts of papers to be read at society meetings.