Assessing the Efficacy of Human Chorionic Gonadotropin Versus Testosterone in Managing Post-Orchiopexy Testicular Atrophy: A Study from a Resource-Constrained Healthcare Facility

Abstract

Cryptorchidism, affecting 1–4% of full-term male infants, poses long-term risks of infertility, hormonal dysfunction, and testicular malignancy if untreated. Orchiopexy, the gold-standard surgical intervention, aims to reposition the testes into the scrotum to preserve fertility and hormonal function. However, postoperative testicular atrophy, characterized by a ≥20% reduction in testicular volume, can undermine these benefits, necessitating adjuvant therapies to salvage compromised gonadal tissue. This prospective, randomized, single-center cohort study evaluated the efficacy of human chorionic gonadotropin (hCG) versus testosterone in managing testicular atrophy following orchiopexy in pediatric patients. Participants were randomized 1:1 into two treatment arms using block randomization (block size = 4) stratified by laterality (unilateral vs. bilateral). For the normality test, the Shapiro-Wilk test was used to verify the normal distribution of continuous variables. Between-group comparisons; an independent samples t-test was used for comparing mean testicular volumes and Doppler parameters (PSV, RI) between Group A and Group B at each time point. Data were analyzed using Statistical Package for the Social Sciences (SPSS) v.27 (IBM Corp.) and R software v.4.1.2 (IBM, free, open-source software environment for statistical computing and graphics), with significance set at p < 0.05.  A higher proportion of patients achieved significant testicular volume gain (responders, defined as patients achieving a ≥50% increase in testicular volume at 6 months). This was observed in 21 (87.5%) patients in the hCG group and 18 (78.3%) in the testosterone group (p = 0.37). This underscores the superior efficacy of hCG therapy in inducing testicular growth.  Our findings support hCG as the preferred therapy for post-orchiopexy atrophy due to its effectiveness in restoring testicular volume and perfusion. Starting hormonal treatment 4 to 6 weeks after surgery balances recovery and therapeutic benefits, aiming to improve testicular development and function while reducing risks of early or late initiation.