The predictive value of inguinal herniography for the diagnosis and treatment of cryptorchidism

Purpose: We evaluated the role of a patent processus vaginalis for cryptorc hidism as well as inguinal herniography as a predictor of the efficacy of h uman chorionic gonadotropin (HCG) treatment, Materials and Methods: We studied 244 boys with unilateral and 66 with bila teral cryptorchidism. All patients underwent inguinal herniography and rece ived HCG. Nonresponders to treatment subsequently underwent orchiopexy, whe n processus vaginalis status, testicular position and epididymal characteri stics were assessed. Results: HCG was effective for 139 of 281 testes (49.5%) with an obliterate d and 0 of 95 with a patent processus vaginalis on herniography. We further evaluated herniography in accordance with orchiopexy findings of persisten t unilateral and bilateral cryptorchidism in 206 boys (237 testes) after HC G, Herniography findings of processus vaginalis morphology revealed a close correlation with that reported by the surgeon after orchiopexy (p <0.00000 5). The incidence of a patent processus vaginalis increased as testicular p osition became more caudal. The processus vaginalis was obliterated in all cases of anorchia. The incidence of more severe epididymal anomalies decrea sed as the testicular position became more caudal. Epididymal abnormalities were more common when the processus vaginalis was patent. Conclusions: Pretreatment herniography assessment of processus vaginalis mo rphology is of prognostic value for predicting the efficacy of hormone trea tment, the presence or absence of testes when they are nonpalpable and futu re fertility.