Objectives

To systematically evaluate the effect of adjunctive hormonal therapy on testicular descent and spermatogenic function among children with cryptorchidism.

Methods

A comprehensive literature search of electronic databases up to February 21, 2019 was performed. Continuous data of fertility indices were evaluated using weighted mean difference (WMD) with 95% confidence interval (CI), while nominal data of fertility indices and the complete descent rates were analyzed by risk ratio (RR) with 95% CI. A fixed effect or random effect model was used.

Results

A total of 27 previous studies were included for the current analysis. Hormonal therapy increased complete testicular descent rate, reaching statistical significance (RR = 3.74; 95% CI, 2.78–5.04; P < 0.001). The success rate was 22.43%. A similar result was found in subgroup analysis of hormonal category and effect on unilateral or bilateral cryptorchidism. Studies reporting primary outcome as continuous data showed that cryptorchid males have significantly increased germ cell numbers per tubule (WMD = 0.10; 95% CI, 0.01–0.20, P = 0.032) after hormonal therapy. The nominal data of pooled studies showed no significant difference (RR = 1.62; 95% CI, 0.65–4.00, P = 0.298). In addition, a significant result was noted in the luteinizing hormone–releasing hormone (LHRH) therapy group but not in those undergoing human chorionic gonadotropin (hCG) treatment.

Conclusions

Our findings have demonstrated that hormonal therapy can effectively increase the success rate of complete testicular descent, while some boys may benefit as regards improvement of the fertility index.

中文翻译：

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辅助激素治疗对隐睾儿童睾丸下降和生精功能的影响：系统评价和荟萃分析

目标

系统评价激素辅助治疗对隐睾儿童睾丸下降和生精功能的影响。

方法

对截至 2019 年 2 月 21 日的电子数据库进行了全面的文献检索。生育指数的连续数据采用加权平均差（WMD）和95%置信区间（CI）进行评估，生育指数的名义数据和完全下降率采用95%CI的风险比（RR）进行分析。使用固定效应或随机效应模型。

结果

本次分析共纳入了 27 项既往研究。激素治疗增加了睾丸完全下降率，达到了统计学显着性（RR = 3.74；95% CI，2.78–5.04；P < 0.001）。成功率为22.43%。在激素类别和对单侧或双侧隐睾症的影响的亚组分析中发现了类似的结果。将主要结果报告为连续数据的研究表明，在激素治疗后，隐睾雄性每小管的生殖细胞数量显着增加（WMD = 0.10；95% CI，0.01–0.20，P = 0.032）。汇总研究的名义数据显示无显着差异（RR = 1.62；95% CI，0.65–4.00，P= 0.298）。此外，在促黄体激素释放激素 (LHRH) 治疗组中观察到显着结果，但在接受人绒毛膜促性腺激素 (hCG) 治疗的患者中则没有。

结论

我们的研究结果表明，激素治疗可以有效提高睾丸完全下降的成功率，而一些男孩可能会在生育指数的提高方面受益。