| Objective1. To provide experimental bases to clinic and study the reproductive endocrinic mechanisms of cryptorchidism by measuring serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) and testosterone (T) in different age of patients with cryptorchidism and health men.2. To study the therapeutic efficacy and the optimal timing of cryptorchidopexy by measuring serum levels of FSH, LH, E2 and T before and after orchidopexy.3. To identify the pathological changes of the adult patients with cryptorchidism, especially the ultrastructural, and investigate the reproductive potential of cryptorchidism.Methods1. Serum levels of FSH, LH, E2 and T in 87 patients with cryptorchidism and in 50 heath men at different age were measured by Chemi luminescence immunoassay (CLIA), and all the data were statisticsed and analyzed.2. Serum levels of FSH, LH, E2 and T were measured in the patients 6 months after orchidopexy by CLIA, and compared to that before operation. The data of the fertility of patients underwent orchidopexy during 1984 to 2003 in the First Affiliated Hospital of Jinan University were followed up by letter.3. The testicles resected from the adult patients with cryptorchidismwereobserved by optical microscope and electron microscope.Results1. Among the 87 patients with cryptorchidism, the superior position type of testes were more common in 1 to 3-year-old group (34. 5%), whereas the lower position type were more common in 9 to 13-year-old group and more than 18-year-old group (58.3%), The difference was significant (P <0. 05). Compared with that of the health men, the level of T was significantly lower, while those of FSH, LH and E2 were higher in 4 to 8-year-old children with cryptorchidism (P <0.05), and LH was extremely higher (P < 0.01); the level of T was significantly lower, while the levels of FSH and E2 were significantly higher in 14 to 18-year-old group (P <0.05); the level of E2 was significantly higher in more than 18-year-old group (P<0.05).2. Compared with the preoperative levels, the postoperative levels of T and FSH increased significantly (P <0. 05), while the level of E2 decreased significantly (P<0.05), but the postoperative level of LH could not change (P >0.05). The results of following up of the fertility of 43 patients were the fertility after orchidopexy was slightly higher in less than 4-year-old group than in 4 to 13-year-old group and the fertility after orchidopexy of bilateral cryptorchidism was significantly lower than that of unilateral cryptorchidism.3. Secondary spermatocyte and sperm could not be found by electron microscope in the testicle resected in the adult patients with cryptorchidism, but spermatogonium and primary spermatocyte could be found, the nucleus and organelle (such as mitochondrion, endoplasmic reticulum, Golgi apparatus) of spermatogonium and primary spermatocyte developed normally in principle. Most of Sertoli cell were immaturate category (Sa and Sb category), less of Sertoli cellwere maturate category. In the Leydig cell, the mitochondrion developed normally, the content of endoplasmic reticulum and lipid droplet were reduced and Golgi apparatus could not be found.Conclusions1. Serum levels of FSH, LH, E2 and T increase gradually along with the increasing age in the patients with cryptorchidism and health men, but their amplification are different.2. Functional disorders of the hypothalamic-pituitary-gonadal axis at different degree exist in all the patients. Comparing to those of the health men, serum levels of FSH, LH and E2 are higher and that of T is lower.3. The functional disorder of the hypothalamic-pituitary-gonadal axis in the patients before 4 years is milder and that after Puberty is severe. So it must treat as early as possible.4. Cryptorchidopexy is beneficial to restoring of testicular's reproductive endocrinic function, and is a reliable treatment for cryptochidism. It suggests that cryptorchidopexy should be proceeded when the patients are no more than 4 years old. Because the adult undescendent testis loss the natural function of spermatogenesis in principal, orchiectomy is the better methods.5. Spermatogonium and primary spermatocyte still exist in the adult cryptorchidism, and their cellular structures and organelles are normal in principal, so the undescendent testis after Puberty still possesses the potential of normal spermatogenesis. So it's possible to retain the fertility in infertilititive patients with cryptorchidism by assisted reproduction.
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