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Ferment, a sign of progress in any scientific field, has previously
been lacking in the area of cryptorchidism, where the only activity
has been in improving operative methods. Now, however, profound
changes in the care of boys with cryptorchidism are being brought
about; ideas are arising from a fresh look at comparative anatomy,
and histological and experimental observa tions are being
supplemented by clinical tests made possible by new hormonal
agents. The treatment of cryptorchidism begins with its recognition
by the pediatri cian, who until now has shown little interest
because of disappointing results from chorionic gonadotropin
administration. As for the surgeon, his bent toward restoration of
normal anatomical relationships has kept his attention focused on
the development of better surgical technics to bring the recalci
trant testis into the scrotum. Both specialists have avoided the
primordial question of why the testis did not descend properly. If
this were known they would treat the cause of cryptorchidism, and
not be satisfied merely with trying to correct its end result. As
one reads this book, one sees that in most patients cryptorchidism
is not caused by some anatomical structure blocking the way or by
some deformity of the testis interfering with the transport
mechanism. Rather, deficiencies in the hormonal environment of the
fetus retard the developmen tal sequences essential to the normal
differentiation and descent of the testis. The clinical solution is
thus to provide the deficient substances."
The subject matter in this volume was derived from papers presented
at the Pediatric Andrology session of the 1st Pan American Congress
of Andrology held in Caracas, Venezuela in February 1979, as well
as from selected additional manuscripts of interest in this field.
Prior to this session, identification of a distinct discipline and
specialty devoted to pediatric andrology had not occurred, nor had
it been conceptualized. Pediatric andrology encompasses many
different areas: disorders of sexual development, structural
disease of the genital organs, normal and abnormal puberty,
undescended testes, genital tumors, gonadal function and its
relationship to growth, virilization, fertility and gender identity
all represent areas of specific interest, to name but a few.
Andrology itself is a unique field, bringing together clinicians
and basic scientists with diverse back grounds. It should be noted
that between one-half and three-quarters of the clinicians
contributing to this issue conduct basic research as well. It has
been this unique blend of basic research and clinical medicine
which has done much to unravel many of these problems
characteristic of this field."
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