Impact of hormonal and surgical interventions versus surgery alone on fertility potential in undescended testes: A systematic review and meta-analysis.

IF 1.9 3区 医学 Q2 PEDIATRICS
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.

激素和手术干预对隐睾生育潜力的影响:系统回顾和荟萃分析。
背景:激素治疗作为手术治疗隐睾(UDT)的辅助手段仍然存在争议。它对未来生育的影响尚不清楚,全球的临床实践也各不相同。目的:评价激素联合手术治疗与单纯手术治疗对男性UDT生育潜力的影响。研究设计:按照PRISMA 2020指南进行系统评价和荟萃分析。检索的数据库包括PubMed、Scopus、Embase、ClinicalTrials.gov和Cochrane,截止日期为2025年4月14日。符合条件的研究是随机对照试验和队列研究,比较激素联合手术治疗与单独手术治疗,报告与生育相关的潜力。使用RoB 2.0或Newcastle-Ottawa量表评估偏倚风险,使用RevMan 5.4进行数据综合。结果:纳入9项研究,652例患者。激素治疗联合手术显著增加每小管精原细胞数量(平均差值[MD] 0.23; 95% CI: 0.07 ~ 0.38; p = 0.003),双侧UDT效果更明显(MD 0.35; 95% CI: 0.17 ~ 0.53; p = 0.001)。然而,在精子数量、抑制素B或睾酮等长期生育指标上没有观察到显著的改善。联合组FSH水平略低(MD: -0.77 IU/L; 95% CI: -1.29至-0.26;p = 0.003)。结论:辅助激素治疗可促进早期生殖细胞成熟,特别是双侧UDT。然而,目前的证据并没有显示出与生育相关的潜力有明确的长期益处。未来的高质量、生物标志物分层和纵向研究是必不可少的,并应包括精子计数和父系等直接终点,以充分确定睾丸切除术前激素治疗的临床应用。
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来源期刊
Journal of Pediatric Urology
Journal of Pediatric Urology PEDIATRICS-UROLOGY & NEPHROLOGY
CiteScore
3.70
自引率
15.00%
发文量
330
审稿时长
4-8 weeks
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.
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