Hormonal therapy using gonadotropin releasing hormone for improvement of fertility index among children with cryptorchidism: a meta-analysis and systematic review

Abstract Background/Purpose Gonadotropin releasing hormone(GnRH) as an adjunct to orchidopexy for the treatment of cryptorchidism is still controversial. Present evidences were studied through a meta-analysis of comparative clinical trials. Method Systematic literature search was done up to Septembe...

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Veröffentlicht in:Journal of pediatric surgery 2014-11, Vol.49 (11), p.1659-1667
Hauptverfasser: Chua, Michael E, Mendoza, Jonathan S, Gaston, Michael John V, Luna, Saturnino L, Morales, Marcelino L
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container_end_page 1667
container_issue 11
container_start_page 1659
container_title Journal of pediatric surgery
container_volume 49
creator Chua, Michael E
Mendoza, Jonathan S
Gaston, Michael John V
Luna, Saturnino L
Morales, Marcelino L
description Abstract Background/Purpose Gonadotropin releasing hormone(GnRH) as an adjunct to orchidopexy for the treatment of cryptorchidism is still controversial. Present evidences were studied through a meta-analysis of comparative clinical trials. Method Systematic literature search was done up to September 30, 2013. Studies were independently appraised by two reviewers. Continuous data of fertility indices were extracted as weighted mean difference (WMD) and standard deviation (SD); while nominal data of fertility indices were extracted as relative risk (RR). Random effects model was used to analyze the pooled effect estimates. Inter-study heterogeneity and publication bias were assessed. PROSPERO Protocol registration (CRD42013004922). Results Ten eligible studies were included. The pooled effect estimates showed that cryptorchid children treated with GnRH when compared with controls, have significantly increased germ cell per tubule (WMD: 0.35; 95% CI 0.07–0.62, P = 0.01) and increased RR to have normal value of germ cell per tubule (RR: 2.86; 95% CI 1.73–4.71, P < 0.0001). Inter-study heterogeneity was noted, source identified with subgroup analysis. Publication bias was not evident. No GnRH related adverse events were reported in all studies. Conclusion Evidence suggests that a subset of boys with cryptorchidism may benefit from GnRH as adjunctive to orchidopexy in improving the fertility index. However, future studies are recommended to specifically identify subgroup characteristics of cryptorchidism that will clearly benefit from the treatment.
doi_str_mv 10.1016/j.jpedsurg.2014.06.013
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Present evidences were studied through a meta-analysis of comparative clinical trials. Method Systematic literature search was done up to September 30, 2013. Studies were independently appraised by two reviewers. Continuous data of fertility indices were extracted as weighted mean difference (WMD) and standard deviation (SD); while nominal data of fertility indices were extracted as relative risk (RR). Random effects model was used to analyze the pooled effect estimates. Inter-study heterogeneity and publication bias were assessed. PROSPERO Protocol registration (CRD42013004922). Results Ten eligible studies were included. The pooled effect estimates showed that cryptorchid children treated with GnRH when compared with controls, have significantly increased germ cell per tubule (WMD: 0.35; 95% CI 0.07–0.62, P = 0.01) and increased RR to have normal value of germ cell per tubule (RR: 2.86; 95% CI 1.73–4.71, P &lt; 0.0001). Inter-study heterogeneity was noted, source identified with subgroup analysis. Publication bias was not evident. No GnRH related adverse events were reported in all studies. Conclusion Evidence suggests that a subset of boys with cryptorchidism may benefit from GnRH as adjunctive to orchidopexy in improving the fertility index. However, future studies are recommended to specifically identify subgroup characteristics of cryptorchidism that will clearly benefit from the treatment.</description><identifier>ISSN: 0022-3468</identifier><identifier>EISSN: 1531-5037</identifier><identifier>DOI: 10.1016/j.jpedsurg.2014.06.013</identifier><identifier>PMID: 25475814</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Child ; Cryptorchidism ; Cryptorchidism - drug therapy ; Cryptorchidism - physiopathology ; Fertility - drug effects ; Fertility index ; Gonadotropin releasing hormone ; Gonadotropin-Releasing Hormone - therapeutic use ; Humans ; Male ; Meta-analysis ; Pediatrics ; Sperm parameters ; Surgery ; Systematic review</subject><ispartof>Journal of pediatric surgery, 2014-11, Vol.49 (11), p.1659-1667</ispartof><rights>Elsevier Inc.</rights><rights>2014 Elsevier Inc.</rights><rights>Copyright © 2014 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c423t-a4ac5c8a7efaca789c7884dcbd2bea6637a62664f9262ea5a4275071419549753</citedby><cites>FETCH-LOGICAL-c423t-a4ac5c8a7efaca789c7884dcbd2bea6637a62664f9262ea5a4275071419549753</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jpedsurg.2014.06.013$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25475814$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chua, Michael E</creatorcontrib><creatorcontrib>Mendoza, Jonathan S</creatorcontrib><creatorcontrib>Gaston, Michael John V</creatorcontrib><creatorcontrib>Luna, Saturnino L</creatorcontrib><creatorcontrib>Morales, Marcelino L</creatorcontrib><title>Hormonal therapy using gonadotropin releasing hormone for improvement of fertility index among children with cryptorchidism: a meta-analysis and systematic review</title><title>Journal of pediatric surgery</title><addtitle>J Pediatr Surg</addtitle><description>Abstract Background/Purpose Gonadotropin releasing hormone(GnRH) as an adjunct to orchidopexy for the treatment of cryptorchidism is still controversial. Present evidences were studied through a meta-analysis of comparative clinical trials. Method Systematic literature search was done up to September 30, 2013. Studies were independently appraised by two reviewers. Continuous data of fertility indices were extracted as weighted mean difference (WMD) and standard deviation (SD); while nominal data of fertility indices were extracted as relative risk (RR). Random effects model was used to analyze the pooled effect estimates. Inter-study heterogeneity and publication bias were assessed. PROSPERO Protocol registration (CRD42013004922). Results Ten eligible studies were included. The pooled effect estimates showed that cryptorchid children treated with GnRH when compared with controls, have significantly increased germ cell per tubule (WMD: 0.35; 95% CI 0.07–0.62, P = 0.01) and increased RR to have normal value of germ cell per tubule (RR: 2.86; 95% CI 1.73–4.71, P &lt; 0.0001). Inter-study heterogeneity was noted, source identified with subgroup analysis. Publication bias was not evident. No GnRH related adverse events were reported in all studies. Conclusion Evidence suggests that a subset of boys with cryptorchidism may benefit from GnRH as adjunctive to orchidopexy in improving the fertility index. However, future studies are recommended to specifically identify subgroup characteristics of cryptorchidism that will clearly benefit from the treatment.</description><subject>Child</subject><subject>Cryptorchidism</subject><subject>Cryptorchidism - drug therapy</subject><subject>Cryptorchidism - physiopathology</subject><subject>Fertility - drug effects</subject><subject>Fertility index</subject><subject>Gonadotropin releasing hormone</subject><subject>Gonadotropin-Releasing Hormone - therapeutic use</subject><subject>Humans</subject><subject>Male</subject><subject>Meta-analysis</subject><subject>Pediatrics</subject><subject>Sperm parameters</subject><subject>Surgery</subject><subject>Systematic review</subject><issn>0022-3468</issn><issn>1531-5037</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkkFv1DAQhSMEokvhL1Q-ckmwHdvJckCgCihSJQ7A2Zq1J7sOSRxsp23-Dr8Ub7flwIWTpadv5un5TVFcMFoxytSbvupntHEJ-4pTJiqqKsrqJ8WGyZqVktbN02JDKedlLVR7VryIsac0y5Q9L864FI1smdgUv698GP0EA0kHDDCvZIlu2pN91qxPwc9uIgEHhHv5cE8j6XwgbpyDv8ERp0R8RzoMyQ0urcRNFu8IZHBPzMENNuBEbl06EBPWOfmQRevi-JYAGTFBCdl_jS4SmCyJa0w4QnIm-944vH1ZPOtgiPjq4T0vfnz6-P3yqrz--vnL5Yfr0ghepxIEGGlaaLADA027NU3bCmt2lu8QlKobUFwp0W254ggSBG8kbZhgWym2jazPi9envTnWrwVj0qOLBocBJvRL1ExJLpiUimVUnVATfIwBOz0HN0JYNaP62I_u9WM_-tiPpkrnfvLgxYPHshvR_h17LCQD708A5qQ5fdDROJwMWhfQJG29-7_Hu39WmMFNzsDwE1eMvV9C_u-cR0euqf52vJLjkTBBqeB8W_8BW2O-3A</recordid><startdate>20141101</startdate><enddate>20141101</enddate><creator>Chua, Michael E</creator><creator>Mendoza, Jonathan S</creator><creator>Gaston, Michael John V</creator><creator>Luna, Saturnino L</creator><creator>Morales, Marcelino L</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20141101</creationdate><title>Hormonal therapy using gonadotropin releasing hormone for improvement of fertility index among children with cryptorchidism: a meta-analysis and systematic review</title><author>Chua, Michael E ; Mendoza, Jonathan S ; Gaston, Michael John V ; Luna, Saturnino L ; Morales, Marcelino L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c423t-a4ac5c8a7efaca789c7884dcbd2bea6637a62664f9262ea5a4275071419549753</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Child</topic><topic>Cryptorchidism</topic><topic>Cryptorchidism - drug therapy</topic><topic>Cryptorchidism - physiopathology</topic><topic>Fertility - drug effects</topic><topic>Fertility index</topic><topic>Gonadotropin releasing hormone</topic><topic>Gonadotropin-Releasing Hormone - therapeutic use</topic><topic>Humans</topic><topic>Male</topic><topic>Meta-analysis</topic><topic>Pediatrics</topic><topic>Sperm parameters</topic><topic>Surgery</topic><topic>Systematic review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chua, Michael E</creatorcontrib><creatorcontrib>Mendoza, Jonathan S</creatorcontrib><creatorcontrib>Gaston, Michael John V</creatorcontrib><creatorcontrib>Luna, Saturnino L</creatorcontrib><creatorcontrib>Morales, Marcelino L</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of pediatric surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chua, Michael E</au><au>Mendoza, Jonathan S</au><au>Gaston, Michael John V</au><au>Luna, Saturnino L</au><au>Morales, Marcelino L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hormonal therapy using gonadotropin releasing hormone for improvement of fertility index among children with cryptorchidism: a meta-analysis and systematic review</atitle><jtitle>Journal of pediatric surgery</jtitle><addtitle>J Pediatr Surg</addtitle><date>2014-11-01</date><risdate>2014</risdate><volume>49</volume><issue>11</issue><spage>1659</spage><epage>1667</epage><pages>1659-1667</pages><issn>0022-3468</issn><eissn>1531-5037</eissn><abstract>Abstract Background/Purpose Gonadotropin releasing hormone(GnRH) as an adjunct to orchidopexy for the treatment of cryptorchidism is still controversial. 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Inter-study heterogeneity was noted, source identified with subgroup analysis. Publication bias was not evident. No GnRH related adverse events were reported in all studies. Conclusion Evidence suggests that a subset of boys with cryptorchidism may benefit from GnRH as adjunctive to orchidopexy in improving the fertility index. However, future studies are recommended to specifically identify subgroup characteristics of cryptorchidism that will clearly benefit from the treatment.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>25475814</pmid><doi>10.1016/j.jpedsurg.2014.06.013</doi><tpages>9</tpages></addata></record>
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subjects Child
Cryptorchidism
Cryptorchidism - drug therapy
Cryptorchidism - physiopathology
Fertility - drug effects
Fertility index
Gonadotropin releasing hormone
Gonadotropin-Releasing Hormone - therapeutic use
Humans
Male
Meta-analysis
Pediatrics
Sperm parameters
Surgery
Systematic review
title Hormonal therapy using gonadotropin releasing hormone for improvement of fertility index among children with cryptorchidism: a meta-analysis and systematic review
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