***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A double-blind , placebo-controlled study of the efficacy of LH-RH nasal spray in treatment of cryptorchidism involving 252 prepuberal boys with 301 undescended testes , showed a success rate of 9 % ( 14 testes ) for LH-RH and 8 % ( 10 testes ) for placebo . Including a subsequent open study and a second course of LH-RH as required , the rate for  LH-RH  rose to 18 % ( 48 testes ) . The follow-up period saw late descent in another 5 % ( 14 testes ) , in a few cases coinciding with the onset of puberty . Retrospective evaluation revealed a previous scrotal position of the testes for 43 % of the boys with success of treatment and even for 17 % of the boys with failure of treatment . In many of these cases surgery revealed an anatomical anomaly that might have caused testicular ascent . Hormonal evaluation revealed no abnormalities in cryptorchid boys  compared with control subjects , nor was there a divergence in values before and after treatment . The lower the pretreatment testicular position , the better the rate of success In a modified , double‐blind controlled study , 163 prepubertal boys ( aged 1.8–13.0 years ) with bilateral and 94 ( aged 1.5–13.1 years ) with unilateral cryptorchidism were allocated to treatment with either human chorionic gonadotropin ( i m ) , gonadotrophin releasing hormone ( intranasally ) or placebo ( intranasally ) . In individuals with the bilateral condition treatment with human chorionic gonadotrophin result ed in complete descent of both testes in 23 % of patients . Treatment with human chorionic gonadotrophin in unilateral cryptorchidism result ed in complete descent in 19 % of patients ; all results were significantly better than those obtained with gonadotrophin releasing hormone or placebo . Linear and logistic regression analysis of the results obtained by treatment of bilateral disease showed that all treatments were more successful the younger the age of the boys . The data indicated that bilateral and unilateral cryptorchidism respond differently to hormonal treatment . We suggest that human chorionic gonadotrophin should be the first choice of treatment for prepubertal boys older than one year Forty boys with 54 incompletely descended testes took part in a double blind , controlled trial of intranasal luteinising hormone releasing hormone . In the control ( placebo ) group of 18 boys there was no significant change in testicular descent and all required orchidopexy ;  in the 22 treated boys , however , 12 of 29 testes ( 42 % ) were found in a lower position . This study supports the idea that a trial of intranasal luteinising hormone releasing hormone ( 1200 micrograms/day for 28 days ) will help clarify the need for orchidopexy in at least 30 % of boys with incomplete descent of the testis , particularly those in whom the testes have emerged from the inguinal canal The effects of hormonal treatment ( LH-RH , LH-RH plus hCG ) on undescended testis were studied on 42 testicles in 37 boys under 3 years of age .  Descensus was achieved primarily in 40 % but eight testicles reascended . A new course of hCG result ed in descensus in three cases . Altogether , therefore , full descensus could be achieved in 29 % of cases with hormonal treatment . Hormonal treatment is recommended before surgery Two courses of LHRH nasal spray ( 400 micrograms three times a day for 28 days ) , partly administered in a double-blind placebo-controlled study , result ed in the descent of 48 of 281 testes ( 18 % ) in 237 prepuberal boys . Logistic regression analysis confirmed the clinical observation that pretreatment testicular position was the major factor influencing treatment results : the lower the pretreatment testicular position , the better the result . Of the unsuccessfully treated boys , 170 with 196 undescended testes subsequently underwent orchiopexy revealing anatomic anomalies that accounted for failure of hormonal treatment in 80 % of the cases . Most frequent finding amounted to an underdeveloped processus vaginalis , extending no further than the level of the pubic bone , often associated with major epididymal deformities and a lack of obliteration of the processus vaginalis ( 107 of 196 operations ) . Obstruction of the scrotal entrance due to abnormal Scarpa 's fascia or abnormal gubernacular remnant was found in 35 and testicular absence in 15 cases . LHRH nasal spray might be effective when the testis can be manipulated to at least the scrotal entrance before treatment , but in view of our surgical findings , LHRH nasal spray will not replace orchiopexy This r and omized double-blind placebo-controlled study was initiated to analyze the behavior of epididymis , processus vaginalis and testicular descent in cryptorchid boys treated with a low dose ( 20 μg ) of a  luteinizing hormone-releasing hormone analogue ( Buserelin ) , administered daily , as a nasal spray , for a short period ( 28 days ) . Fifty-nine true cryptorchid boys were r and omly assigned to 3 groups : buserelin , treatment [ 22 ] , surgical treatment [ 18 ] or placebo control group [ 19 ] . The 3 groups of patients were similar before treatment in regard to testicular position , chronological and bone age , height and weight , luteinizing hormone , follicle-stimulating hormone , testosterone , penile size and the volume of the contralateral descended testis . None of the patients had retractile testes . Buserelin significantly induced testicular descent compared to the boys treated with a placebo ( P<0.01 ) . A normal epididymis was found more often in boys with successful descent ( P<0.003 ) . A closed processus vaginalis was also more frequently observed in the group treated with buserelin than in surgically treated one ( P<0.05 ) . In conclusion , buserelin was capable of inducing testicular descent besides provoking further development of the epididymis and closing the processus vaginalis The effect of intranasal , synthetic LH-RH ( Hoe 471 ) on  undescended testes  was investigated in : I. a double blind study comprising 50 patients given either placebo or 0.6 mg LH-RH daily and II . an open study comprising 50 patients with a daily dosage of 1.2 mg LH-RH .  In both studies LH-RH was given for 4 weeks . Since some patients had bilateral undescended testes , 116 testes were treated in total . Patients ' ages varied between 11/2 and 101/2 years , with a mean of 5 years . Clinical examination before , during and at end of treatment was performed by both the authors independently . In the placebo group , one testicular descent was seen , indicating difficulty in diagnosis . A therapeutic result , i.e. a significant move from the pretreatment location towards the bottom of the scrotum was seen in 60 % of the testes , complete descent being seen in about 40 % . In a follow-up study 6 months after treatment , in 23 cases with complete descent from a pretreatment inguinal position , relapse was seen in 5 patients ( 2 were located at scrotal neck , 3 at the pretreatment position i.e. inguinal ) . The best results were seen on testes located not too far from the scrotal neck , with the higher dosage of LH-RH and in patients less than 6 years of age . No significant hormonal changes ( testosterone-,LH-or FSH-levels in peripheral blood ) were seen during the study . Side effects were negligible Fifty unilaterally cryptorchid boys aged 3 to 8 years were r and omly and blindly allocated to treatment with luteinizing hormone releasing hormone or placebo intranasally . In the treated group , no significant descent of the undescended testis was found , whereas a minor downward movement of the scrotal testis occurred ( P less than 0.001 ) , probably as a result of decreased retraction by the cremaster muscle . Basal serum testosterone concentrations and testicular volume increased after treatment ( P less than 0.01 and P less than 0.001 , respectively ) . The response to an acute LHRH test , 100 micrograms/m2 body surface IV , before and after treatment , showed an increase in the luteinizing hormone peak value and a decrease in the follicle-stimulating hormone response in a significant number of patients ( P less than 0.001 ) . In the individual patient , there was a positive correlation between the increase in basal serum testosterone concentration and the degree of downward movement of the undescended testis ( P less than 0.05 ) The mode of treatment best for undescended testes is controversial , and local traditions often override knowledge gained from r and omized controlled studies . In order to reach a consensus within the Nordic countries on the current state-of-the-art of treatment , a group of specialists in testicular physiology , paediatric surgery/urology , endocrinology , and rology , pathology and anaesthesiology from all the Nordic countries met for 2 days . Before the meeting , review s of the literature had been prepared by the participants . Judging from published meta-analyses , hormonal treatment has low efficacy . Although 15 - 20 % of retained testes descend during hormonal treatment , one-fifth of these re-ascend later on . Also , treatment with human chorionic gonadotropin ( hCG ) may be harmful to future spermatogenesis through increased apoptosis of germ cells . Orchiopexy  , on the contrary , results in about 95 % anatomical success , with a low ( about 1 % ) risk of complications . The optimal time for orchiopexy has also been debated . However , a recent r and omized controlled study shows that surgery at 9 months of age is followed by a better post-operative growth of the testes than surgery at 3 years , which supports previous arguments for early surgery . The unanimous conclusion of the group was that surgery is generally the preferred mode of treatment , rather than hCG or GnRH treatments . Orchiopexy  should be performed between 6 and 12 months of age , or soon after diagnosis , if that occurs later . If a testis is found to be undescended at any age after 6 months , the patient should be referred for surgery . Referral should be to paediatric rather than general surgeons/urologists if the boy is less than 1 year old , if he has bilateral or non-palpable testes , or if he has got relapse of cryptorchidism In a double‐blind placebo‐controlled study in 49 boys with cryptorchidism the effect of intranasal synthetic LHRH was studied . After 8 weeks improvement in testicular location was found in 13 testes ( 37 % ) , but this improvement was considered sufficient of only six testes . Placebo result ed in an improved location in 18 % of the testes . The mean change in testicular position ( expressed in cm ) after LHRH therapy was slightly greater than after placebo but only in the squatting position did this difference reach significance . Aggressive behaviour was reported in 23 % of the children treated with LHRH . A second LHRH course did not result in significant improvement in any of the patients . At follow‐up reascent was frequently seen . The final results in unilateral cryptorchidism are poorer than those in bilateral cryptorchidism . LHRH therapy leads to higher plasma LH levels and a lower FSH in response to an intravenous LHRH test . In 15 boys plasma testosterone levels rose above 0.4 nmol/1 . We conclude that intranasal LHRH application has a limited value for the treatment of cryptorchidism but may be suitable as a diagnostic test The effect of intranasal luteinising-hormone releasing hormone ( L.H.R.H. ) in 84 boys with unilateral or bilateral cryptorchidism was evaluated in a double-blind controlled trial . Boys with retractile testes were not studied . L.H.R.H. caused no side-effects ; plasma antibodies to L.H.R.H. were never demonstrated . Four weeks ' therapy with intranasal L.H.R.H. administered in six doses daily ( 1.2 mg/day ) led to complete descent in 38 % of a total of 61 testes , an improved position in 28 % , and no response in 19 % ; 15 % of testes were never palpated . After placebo the position of 25 % of testes was improved ; there was no response in 75 % of a total of 51 testes . The success-rate seemed to be independent of age , but was related to the initial testicular position , with complete descent in only 11 % of testes not previously palpated compared with 48 % of testes found in the inguinal region In a double-blind , placebo-controlled multicentre study , the effect of luteinizing-hormone-releasing-hormone ( LHRH ) in 141 boys was analysed after 4-week treatment period with 0.4 mg LHRH nasal spray or placebo nasal spray three times daily . Data from 123 boys was analysed , with 62 boys in the treatment group and 61 in the  placebo group . Full response i.e. the testis at the bottom of the scrotum on both sides in boys with bilaterally undescended testes  , was found in six patients , one of them in the placebo group [ Therapeutic gain of LHRH with 95 % CI : 8.1 % ( 0.1 - 16.6 % , P = 0.12 ) ] . Only 
    Output:
    
There were no significant differences for nonpalpable testes .
Conclusions LHRH had significant benefits on testicular descent , particularly for inguinal and pre-scrotal testes , which was also accompanied by temporary slight side effects