Cryptorchidie et infertilité masculine : Prévalence à l’Hôpital Général de Référence de Panzi (RDC) et effets protecteurs des extraits aqueux et méthanolique des feuilles de Rubus apetalus (Rosaceae) chez le rat

Cryptorchidism (CPT) is a common congenital condition frequently encountered in pediatric surgery. Its prevalence varies across settings, and limited access to health-care facilities may contribute to delayed diagnosis and poor awareness of the condition. According to the World Health Organization (WHO), more than 80% of the African population uses medicinal plants before seeking care from formal health services. However, this rich traditional pharmacopoeia remains insufficiently studied and underutilized in evidence-based medicine.

Several studies have reported the antioxidant properties of plant extracts traditionally used in the empirical treatment of cryptorchidism. Rubus apetalus (Rosaceae), the plant investigated in this study, is commonly used in Bukavu, Democratic Republic of Congo, for the management of cryptorchidism and male infertility, although its therapeutic use has not yet been scientifically validated.

The main objective of this study was twofold: first, to determine the prevalence of cryptorchidism in the pediatric surgery department of Panzi General Reference Hospital in Bukavu, DRC; and second, to investigate the protective effects of aqueous and methanolic extracts of Rubus apetalus leaves by measuring selected fertility parameters in rats with right-sided cryptorchidism. The study also assessed the acute and sub-chronic toxicity of these extracts in mice and rats.

The prevalence of cryptorchidism was determined through a six-year retrospective descriptive study conducted from January 1, 2011, to December 31, 2016. Medical records of children who consulted and underwent surgery were reviewed. Hospital prevalence, socio-demographic characteristics, clinical presentation, therapeutic management, and postoperative outcomes were identified and analyzed using SPSS version 20.

To evaluate the protective effects of R. apetalus on cryptorchidism, Wistar rats aged 8 to 10 weeks and weighing 120–140 g were surgically rendered cryptorchid. Beginning on the third day after surgery, the animals received either aqueous or methanolic extracts of R. apetalus at doses of 12 or 60 mg/kg by oral gavage for two, four, or eight weeks. Control groups received distilled water as a negative control or vitamin E as a positive control.

During the eight-week treatment period, fertility testing was performed by mating each male rat with two females of proven fertility. At the end of the treatment periods, the animals were sacrificed, and blood samples and reproductive organs were collected. These samples were used to assess organ weight, sperm parameters, hormonal levels, oxidative stress markers, and testicular histology.

The safety profile of the extracts was evaluated through acute and sub-chronic toxicity tests. For acute toxicity, mice received a single oral dose of 5000 mg/kg of either aqueous or methanolic extract of R. apetalus, while the negative control group received distilled water. The animals were observed for two weeks for signs of toxicity, including mortality, locomotor activity, aggression, stool condition, and sensitivity to light and noise.

For sub-chronic toxicity, therapeutic and supra-therapeutic doses of the aqueous and methanolic extracts—60, 180, and 540 mg/kg—were administered orally to young male and female rats for four weeks. The animals were monitored and weighed daily, then sacrificed on day 29. Blood and selected vital organs were collected for hematological, biochemical, and histological analyses.

The hospital prevalence of cryptorchidism was 1.5%, corresponding to 76 cases among 5,066 children who underwent surgery. Diagnosis and surgical management were delayed, occurring at mean ages of 5.7 ± 4.6 years and 5.8 ± 4.5 years, respectively. Right-sided unilateral cryptorchidism was the most frequent form, observed in 35 children. In addition, 45 children, representing 59.2% of cases, had at least one associated malformation. Postoperative outcomes were generally uncomplicated.

In the experimental model, right-sided cryptorchidism caused a significant decrease in testicular mass, with statistical significance ranging from p < 0.05 to p < 0.001. Similar reductions were observed in sperm density, motility, and normal morphology, as well as in testicular protein levels and plasma sex hormones. In cryptorchid rats, perivascular fibrosis increased significantly (p < 0.001), while seminiferous tubule diameter, germ cell thickness, gestation rate, and fertility index decreased compared with animals receiving distilled water.

Furthermore, cryptorchidism induced oxidative stress, characterized by increased lipid peroxidation and reduced activity of antioxidant enzymes, including superoxide dismutase (SOD) and catalase. These alterations were significantly prevented by treatment with R. apetalus extracts after two, four, or eight weeks. The extracts also improved fertility parameters when compared with untreated cryptorchid rats.

At the end of the toxicity study, the median lethal dose (LD50) was found to be greater than 5000 mg/kg. All measured parameters remained within normal ranges in animals treated with the plant extracts, indicating low toxicity under the experimental conditions used.

Overall, the findings show that the hospital prevalence of cryptorchidism at Panzi General Reference Hospital was 1.5%. They also demonstrate that aqueous and methanolic extracts of Rubus apetalus improve fertility parameters impaired by unilateral cryptorchidism and exhibit low toxicity. These results provide scientific support for the traditional use of R. apetalus in the management of infertility associated with cryptorchidism.

Keywords: Cryptorchidism; Rubus apetalus; oxidative stress; infertility; toxicity; rat.