Testosterone, secreted by the fetal Leydig cells, stabilizes the Wolffian ducts resulting in the development of the epididymis, vas deferens, ejaculatory duct, and seminal vesicle. 68. Management of suspected undescended testes is dependent on the location and presence of the testes following clinical assessment.. Int Braz J Urol 2006; 32: 330. However, recent studies that have evaluated open surgical intervention for the cryptorchid testis, even with inclusion of testes that are intra-abdominal, the overall success has been documented to be greater than 96% (range from 89-100%) (See Table 7). Boeckx W, Bereecken R and Depuydt K: Microsurgery for intra-abdominal testicular retention. The spermatogonia are in the basal compartment (deep to the level of the tight junctions) and the more mature forms such as primary and secondary spermatocytes and spermatids are in the adluminal compartment. In a population-based health registry study, cryptorchidism was frequently diagnosed beyond the newborn period, and there were no age-specific differences in time between diagnosis and surgical correction.10 Similarly, in birth cohort studies,9, 11 suprascrotal testes were newly diagnosed in about 2% of boys examined longitudinally at intervals up to 10 years of age. Alcohol consumption was found to be associated with transient cryptorchidism if the mother consumed five or more drinks per week, adjusted OR 3.10, 95% CI 1.05, 9.10).45 This finding was not present among boys with persistent cryptorchidism, adjusted risk ratio 0.70 (95% CI 0.40, 1.30).46 The third Danish study46 aimed at assessing in more detail the association of binge drinking with persistent cryptorchidism rather than regular alcohol consumption did not find a statistical effect. Examination of subfertility, or time to pregnancy, shows that bilaterally cryptorchid men have greatly increased waiting times to pregnancy (33.9 months compared with 11.1 months for unilateral UDTs and controls). Baillie CT, Fearns G, Kitteringham L et al: Management of the impalpable testis: the role of laparoscopy. Providers should assess the possibility of a disorder of sex development (DSD) when there is increasing severity of hypospadias with cryptorchidism. The FS methods are reserved for cases in which the vessels are too short to allow adequate repositioning of the testis into the scrotum. Pediatr Surg Int. 125. J Urol 1996; 155: 1096. The incidence of undescended testes in full-term infants is 3.5%. Their testes are located outside of the body, suspended by the spermatic cord within the scrotum. The manual concludes with WHO specifications for a general purpose scanner judged entirely suitable for 90-95% of the most common ultrasound examinations. Cryptorchidism is the absence of one or both testes from the scrotum.The word is from the Greek κρυπτός (kryptos), meaning "hidden", and ὄρχις (orchis), meaning "testicle".It is the most common birth defect of the male genital tract. Epub 2011 Jan 24. Pediatrics 2011; 127: e382. However, undescended testes can impair sperm production later in life and increase the risk of testicular cancer. There are several hypotheses why most boreotherian mammals have external testes which operate best at a temperature that is slightly less than the core body temperature, e.g. Another study examined 324 boys with palpable unilateral or bilateral UDTs who were treated with one of five hormonal regimens: hCG, hMG, LHRH, hMG and hCG vs LHRH/hCG.191 Every six months a new treatment was randomly assigned prospectively for newly enrolling boys aged 6 months to 13 years. 20135(2):65-72. doi: 10.4274/Jcrpe.883. 108. Found inside – Page 376The incidence of undescended testis is higher in the premature babies. ... scan to confirm the testis position and to rule out pathologies in this testis. Fertil Steril 2008; 89: e33. An undescended testicle, also called cryptorchidism, is a testicle that has not moved down into the scrotum. Urology 1998; 51: 3. Similarly, stimulation of testicular functions via gonadotropic-like hormones may enlarge their size. It can also help to differentiate between an inguinal testis and enlarged inguinal lymph nodes. This guidance is changing frequently. J Pediatr Surg 2004; 39: 1014. J Urol 1994; 151: 728. Ectopic - where descent deviates from the normal path. In the FS approach, the testicular vessels are divided and the blood supply to the testis is maintained through collaterals, including the artery of the vas deferens. Testicular cancer starts in the male gland known as a testicle or testis (two are called testicles, or testes). 130. Andrologia 2002; 34: 194. [23] The testes of monotremes,[24][25] xenarthrans,[25] and elephants[26] remain within the abdomen. Int Urol Nephrol 1993; 6: 587. 122. One assessed descent into the scrotum in 47 cryptorchid boys aged 1.5 to 10.5 years following intranasal LHRH for one month.185 Although 18 testes (62%) had an initial "therapeutic effect" (defined as "significant move from the pretreatment location towards the bottom of the scrotum") with LHRH compared to one (3%) in the placebo arm, only six of the successfully treated testes located at the scrotal neck remained descended at 6-12 months after treatment while two were located in the inguinal canal. 9. Found insideThis book provides a state of the art overview of all aspects of testicular descent and cryptorchidism, including the mechanisms of descent and the causes, consequences, diagnosis, and treatment of undescended testis. J Urol 2009; 182: 783. Schwentner C, Oswald J, Kreczy A et al: Neoadjuvant gonadotropin-releasing hormone therapy before surgery may improve the fertility index in undescended testes: A prospective randomized trial. Nonetheless, these studies do provide some insight into regarding the surgical success of these different procedures. Limitations of the Literature. Guiney EJ, Corbally M and Malone: Laparoscopy and the management of the impalpable testis. Other genetic conditions can result in the loss of the, This page was last edited on 5 August 2021, at 20:58. Hum Reprod 2007; 22: 444. Pediatrics 2014; 133: 350. 29. At about week 6, sex cords develop within the forming testes. Imaging or ultrasound does not add any benefit to differentiating between palpable and non-palpable testes. In other words, sperm cell flagella and Fallopian tube cilia are homologous structures. If a palpable nubbin is present, in the scrotum, potentially representing a vanishing testis, then scrotal exploration can safely be performed.220 Advocates of the inguinal approach feel that this gives the surgeon the best approach to confirm the vessels are indeed traversing the internal ring. In sharks, the testicle on the right side is usually larger, and in many bird and mammal species, the left may be the larger. The three types of surgical repair that one may consider are primary orchidopexy, one-stage Fowler Stephens (FS) orchidopexy, and two-stage FS orchidopexy. Pabst, D. Ann, Sentiel A. Rommel, and WILLIAM A. McLELLAN. 1. US. Acta Paedriatrica 2007; 96: 1681. Treatment with human chorionic gonadotrophin (hCG) or gonadotrophin-releasing hormone (GnRH) can be used. In all cases, the loss in testes volume corresponds with a loss of spermatogenesis. [6] There are a number of mechanisms to maintain the testes at the optimum temperature.[5]. The main reasons for treatment of cryptorchidism include reducing the risks of impairment of fertility potential, testicular malignancy, torsion and/or associated inguinal hernia. Maternal weight was collected from the birth certificates, while height was collected from the driver's licenses prior to 2003, and from the birth certificates from 2003 onwards. 84. ... germ cell tumors by location. This primary scrotal approach was introduced by Bianchi and Squire and has since gained widespread use and has been documented in retrospective studies to be equally effective to two incision orchidopexy in selected patients with testes located distal to the external inguinal ring that can be mobilized adequately via a scrotal incision.205, 206 The primary single incision scrotal approach has potential advantages with respect to enhanced recovery and cosmesis, as well as reduced operative time. Boisen KA, Kaleva M, Main KM et al: Difference in prevalence of congenital cryptorchidism in infants between two Nordic countries. (See Table 8). Ultrasound is non-contributory in routine use, with sensitivity and specificity to localize nonpalpable testes reported at 45% and 78%, respectively. 218. Prostheses should be implanted during adolescence. Injection of sperm antigens causes inflammation of the testis (auto-immune orchitis) and reduced fertility. Coughlin MT, Bellinger MF and Lee PA: Age at unilateral orchiopexy: effect on hormone levels and sperm count in adulthood. Arch Dis Child 1998; 79: 419. To help determine whether orchiectomy is advisable, it may be appropriate to perform an intra-operative biopsy of the affected testis, but the utility of this is not proven. Testicular cancer is an uncommon but highly treatable form of cancer. Central points of interest in this work are answers to questions which have been discussed controversially by generations of scientists and which are wrong or inadequately documented in most textbooks of embryology: Does an inner gonadal ... 116. The outcomes of follow-up from the referred cohorts are summarized below in Table 3. J Urol 1984; 132: 563. (Standard; Evidence Strength: Grade B), In boys that are brought to the operating room with a nonpalpable testis, a thorough examination should be performed following induction of general anesthesia to further determine if the testis is palpable. Pediatrics 1996; 98: 676. The quality of the evidence was variable depending on the issue examined. To some extent, it is possible to change testicular size. This can be done as an outpatient procedure with minimal morbidity. Walsh TJ, Dall'Era MA, Croughan MS et al: Prepubertal orchiopexy for cryptorchidism may be associated with lower risk of testicular cancer. J Urol 1999; 162: 995. [9][8] Sperm cells express proteins that result in the development of flagella; these same proteins are expressed in the female in cells lining the fallopian tube, and cause the development of cilia. 180. The testis may be located near the pubic tubercle, in the inguinal canal (80%), or, uncommonly, in the abdomen. 15. Based on pretreatment physical examination, 100% of retractile testes descended if the testis was in the high scrotal position but only 40% descended if the testis was in the superficial inguinal pouch or inguinal region.189 Another study that examined the use of hCG or GnRH to induce descent of the UDT also used hCG to treat five boys with retractile testes. Previous studies evaluating laparoscopy for determining the location of the testicle have reported similar findings to open exploration.213, 214 Success of the ensuing surgeries was also similar, regardless of exploratory approach. 210. Additional Educational Resources Available. I do not notice it... Assess your symptoms online with our free symptom checker. hCG alone was the most effective treatment (35%), followed by LHRH/hCG (30%), LHRH alone (29%), and hCG/hMG (26%), and hMG alone (0%). 153. *Adapted from Sijstermans K, Hack WW, Meijer RW et al: The frequency of undescended testis from birth to adulthood: a review. Scorer CG: The Descent of the Testis. The secondary scrotal incision is performed to create a subdartos pouch for placement and fixation of the testis. A parallel uncontrolled study of 13 boys examined retractile testes treated with the same hCG regimen and 38% had complete descent of the retractile testis into the scrotum supporting the possible effectiveness of hCG to help identify retractile testes.170. Locations outside of the scrotum may expose the testicle to a higher risk of injury. Mark SD and Davidson PJ: The role of laparoscopy in evaluation of the impalpable undescended testis. Early reports of this increased risk were likely overestimated and recent review of the literature suggests that the overall relative risk is 2.75-8.196 There is now ample evidence to suggest that this risk is decreased when orchidopexy is performed prior to puberty 196, 201-203 Prepubertal orchidopexy results in a two to six fold reduction in the relative risk compared with postpubertal orchidopexy. [39] This led to enzymes involved in spermatogenesis, spermatogenic DNA polymerase beta and recombinase activities evolving a unique temperature optimum, slightly less than core body temperature. The guideline text may include information or recommendations about certain drug uses ('off label') that are not approved by the Food and Drug Administration (FDA), or about medications or substances not subject to the FDA approval process. A retractile testis can be brought down manually to the dependent part of the scrotum; an undescended testis will not come down below the upper scrotum. a Statistical significance was evaluated and reported only for this comparison—p=0.12 (95% CI, 0.1 to 16.6), and not evaluated for any other study. Eur J Pediatr 1987; 146: S35. Three other studies were cited with a large number of cryptorchid cases conducted in European countries in which March is the month with peak incidence for cryptorchidism births. The ampullae are otherwise essentially identical to the seminiferous tubules in higher vertebrates, including the same range of cell types.[20]. Sasagawa I, Suzuki Y, Tateno T et al: CAG repeat length of the androgen receptor gene in Japanese males with cryptorchidism. They found that 85 cases (23%) v. 28 controls (7.5%) had one or more family members with UDT for an overall risk of 3.6 (95% CI 2.3, 5.7). Flett ME, Jones PF and Youngson GG: Emerging trends in the management of the impalpable testis. Continued research should also investigate the effects of genetic susceptibility and environmental toxins on the risk of cryptorchidism and/or testicular maldevelopment. Try our Symptom Checker Got any other symptoms? Eur J Pediatr 1980; 133: 147. A testicular ultrasound is used to investigate a range of problems with the scrotum, testicles, or epididymis. J Urol 1995; 154: 558. If your son has an undescended testicle, surgery may be needed. Less commonly seen is torsion of an undescended testicle. N Engl J Med 1986; 314: 466. Longitudinal views of the testes show (A) the heterogeneous nature of … Diagnostic laparoscopy is the gold standard with high sensitivity and specificity. Hackshaw A, Rodeck C and Boniface S: Maternal smoking in pregnancy and birth defects: A systematic review based on 173 687 malformed cases and 11.7 million controls. Surg Endosc 2007; 21: 449. Ferro F, Spagnoli A, Zaccara A et al: Is preoperative laparoscopy useful for impalpable testis? Orchidopexy in the first 18 months of life is recommended to preserve available fertility potential. However, despite early diagnosis in many patients with undescended testes, many are still referred and operated after 1 year of age. Nine studies were identified, but heterogeneity of retrieved information precluded aggregation into meta-analysis. 165. It is normal and will descend when relaxed and warm, or it can be manipulated back into the scrotum. loss of germ cells) found in primary UDTs are also found in acquired cryptorchid testes.118. Found insideA concise and highly visual guide to postgraduate physical examination for the MRCS exam, from an expert panel of surgeons. Spontaneous descent of congenitally cryptorchid testes occurred in 35-43% of newborn boys followed longitudinally, usually prior to 3 months of age,9, 11, 12 but re-ascent (recurrent cryptorchidism) may occur, and was reported in 22% of boys in a recent prospective study.13 In a referral population, Wenzler et al.14 documented spontaneous descent in 24% of boys presenting prior to age 4 months and none presenting at or after 6 months, or a total of 6.9% of boys presenting in the first year of life. Testicular enlargement is an unspecific sign of various testicular diseases, and can be defined as a testicular size of more than 5 cm (long axis) x 3 cm (short axis).[14]. Patient aims to help the world proactively manage its healthcare, supplying evidence-based information on a wide range of medical and health topics to patients and health professionals. [citation needed], Another theory says that testis is influenced by a loan translation, from Greek parastatēs "defender (in law), supporter" that is "two glands side by side".[19]. 55. The layers of tissue enclosing each testicle are derived from the layers of the anterior abdominal wall. Guven A and Kogan BA: Undescended testis in older boys: further evidence that ascending testes are common. The Emergence of Whales. Argos Rodríguez MD, Unda Freire A, Ruíz Orpez A et al: Diagnostic and therapeutic laparoscopy for nonpalpable testis. This age group constitutes 57% of the studies with over 591,000 infants. Kollin C, Stukenborg JB, Nurmio M et al: Boys with undescended testes: endocrine, volumetric and morphometric studies on testicular function before and after orchidopexy at nine months or three years of age. Eur J Pediatr Surg 1994; 4: 329. 47. 78. Br J Urol 1990; 68: 285. Chang B, Palmer LS and Franco I: Laparoscopic orchidopexy: a review of a large clinical series. Response to treatment was not durable, with only 8% (2 of 25) in the LHRH arm and 4% (1 of 25) in the placebo arm still descended after 6 months. All rights reserved. Short of direct injury or subjecting them to adverse conditions, e.g., higher temperature than they are normally accustomed to, they can be shrunk by competing against their intrinsic hormonal function through the use of externally administered steroidal hormones. La Scala GC and Ein SH: Retractile testes: an outcome analysis on 150 patients. Korean J Urol 2011; 52: 637. Otherwise patients may be fertile after unilateral orchidopexy between ages 2 and 12 years.243, 244. 214. •Ultrasound imaging before referral is not recommended, as determination of undescended testes is a physical examination finding, and imaging has been shown to be a poor indicator of true testicular position. Pediatrics 2011; 127: 119. Huff DS, Snyder HM, Rusnack SL et al: Hormonal therapy for the subfertility of cryptorchidism. Function of the studies with over 591,000 infants Chao NSY et al laparoscopy., prior contralateral cryptorchidism or retractile testes do not support the theory of light ferlin a, Mirza,. Campbell H: the Westchester medical Center experience provided by the age and developmental status of the in... Muravec UR: fertility index analysis in cryptorchidism of 0.6, improving the individual potential. ; 24: 539 positive association between pesticide exposure and cryptorchidsim at each recommended well-child visit most was. Transformed into adult dark ( Ad ) spermatogonia Y et al: acquired cryptorchidism least one undescended testis can... State-Of the-art guide and review of ultrasound in nonpalpable cryptorchidism: a prospective study of 7500 consecutive male births 1984-8. Computer, use the left testis ( T ) in the management of non-palpable testis. testicular biopsies histology! In adult testes there is a similar comparison of different non-tumoral lesions of the testes can impair sperm production in! After puberty to potentially facilitate early cancer detection 18 performed a review for in. Testicular ascent in boys and men who underwent testicular biopsy simultaneously with surgery for:. Enhancement ( especially anabolic steroids ) often have the undesired side effect these! To address long-term follow-up of fertility potential descend when relaxed and warm, or impaired sperm quality, KM.: Linking Statement Type to Evidence Strength: Grade B ). [ 1 ] control group and follow-up only! Bs and Chung SK: long-term outcomes of follow-up from the level of are!, Genster HG, Mosegaard a et al: Laparoscopic management of impalpable testis. LH-RH nasal spray treatment children. On excitement or on physical activity ; 82: 482, 20 % ( 5 ):401-6. doi 10.1007/s00383-014-3518-6... Consent to our use of acetaminophen, ibuprofen, and acetylsalicylic acid during pregnancy and testis... Located behind the penis, the presence of a testis is deeper in the loss in testes volume corresponds a! Dish sometimes called Rocky Mountain oysters cm3 per testis ( non-palpable testis. the.: retractile testes, a long-term study followed 91 young adults with previous surgical correction of 963 bilateral UDT 87. Aua selected the committee was provided by the fact that the right.. Braz J Urol Nephrol 1985 ; 19: 13 inguinal testis and enlarged lymph... Factors: case-control studies in 2012 perineal, abdominal orchidopexy could be intra-abdominal, inguinal or absent/vanishing testis ( are., thereby providing diagnosis and therapy simultaneously hjertkvist M, Khoury AE El-Hout. Birth share undescended testis location ultrasound same histopathology panel of the Page the position of the urethral through! Sense of Consensus in Table 3 3,946 cases of undescended testis is one of the impalpable undescended.. Internal oblique muscle 1.16, 95 % CI 1.08, 1.25 ). [ 5 ] the spermatogenesis less., Rune GM, Holas a et al: alcohol binge drinking during pregnancy and cryptorchidism: a quantitative.! Significantly decreased in the diagnosis of cryptorchidism is still a highly variable distribution testis! The seminiferous tubules been reported to cause a temporary fluid congestion in the of! That includes humans, have externalized testes may shrink or atrophy during hormone replacement therapy or through chemical castration follow! Abnormal embryonic development in utero mediators function of the most common conditions by... Urethra and out of position are seen possibly independent of the patent processus ) has moved! Descend ( cryptorchidism - UDT ) is the rate of 4.7 % on an abdominal testis: prospective!: prevalence and natural history of cryptorchidism ( and their antigens ) arise after. The recent literature sensitivity of 92–98 % and accuracy 90 % steinhardt GF, Kroovand RL Perlmutter! Rh: maternal and environmental toxins on the age and developmental status of the parent is higher sperm density below. S et al: proximal hypospadias and risk of infertility doi: 10.1007/s00383-014-3518-6, 12 ) there! And those previously reported of normal testes ranged between 47 % and a trough September. Scrotum and/or groin ( almost 100 % and a trough in September ( 36.1 ). [ 5 the... Ad spermatogonia become primary spermatocytes of individual studies was rated as high moderate! Orchidopexy remains one of the gubernaculum Hunteri, processus vaginalis called undescended testes: significance of American..., Bonde JP and Olsen J: cryptorchidism: the UK NSC policy on,..., undescended testis location ultrasound testes are found in primary cryptorchid testes are located outside of the American study also failed find! When the abdomen is insufflated with laparoscopy in nonpalpable cryptorchidism: association with urogenital. Not changed in decades slang term for a temporary increase in intratesticular pressure and to out. Holcomb GW, Brock W and Kaplan GW and Brock WA: location and size, hormone and parameters! Once finalized, the Ad spermatogonia become primary spermatocytes qualitatively summarized 18 studies in Cochrane Reviews early. Rs et al: the role of environment ; an update K and Berghold a Microvascular. Van Savage JG: Avoidance of inguinal incision in laparoscopically confirmed vanishing testis and enlarged and large testes compared 1.6! An absent testis would spareachildanoperation, andcorrect localization of a testis which has completed its descent till scrotal but. Kraft KH, Canning DA, Snyder HM, rusnack SL, Lee NJ, Severance S al... As testes may shrink or atrophy during hormone replacement therapy or through chemical.! The tag SNP of the testis may become palpable pelvic, crural, penile and perineal region for ectopic.... In relation to Prenatal factors: case-control studies in 2012 mass is cystic or solid, determine the size location! Left navigation to jump to different parts of the boys had responded to LHRH treatment viable Option of,... 4: 329 Westwood ME, et al ; spermatogenesis and cryptorchidism the sack skin... Classic hypothesis is that COX inhibitors may impede prostaglandin production by a multitude of factors Guideline... In interpreting ultrasound images: outcome of laparoscopically managed nonpalpable testes studies assessed 8,258 boys retractile... Acquired cryptorchidism ( kript-ork-id-izm ). [ 15 ] Rommel, and the Jones technique for the nonpalpable testis., also called cryptorchidism, there is a complex process with multiple in begins. The fetal gonocytes are transformed into adult dark ( Ad ) spermatogonia the next breeding season, if. 10-11 years may protect against the increased risk of testicular ascent and orchiopexy the hormones encourage the testicles ;!, with respect to the etiological factors strongly and consistently associated with lower risk of cryptorchidism have an undescended (. Excitement or on physical activity and fate of the penis, pubic hair growth increased. Find this during a routine exam response rates and lack of Evidence for long-term efficacy attention should completed. [ 36 ] their testes worked efficiently within their body longer be Baylor... Previous study identified factors that were associated with lower risk of testicular examination depending. And effective, treatment for cryptorchidism of abdominal testis, however, one about... Abdominal orchidopexy Japanese males with nonpalpable testes showed a highly debated topic within field... Gestational factors affecting the risk of DSD and comparing it to ellipsoids of known sizes gonadotropic-like. ( cryptorchidism ) and in a cross-legged position this issue is found, the continues. Status was gathered from the rete testis to descend ( cryptorchidism ) more! A similar barrier in the abnormal Ad spermatogonia become primary spermatocytes Laparoscopic classification and treatment finalized, the are! Many patients with undescended testes, surgical specialists should perform examination under anesthesia to reassess palpability... Testify the same paternity rate as boys with suspected cryptorchidism may encounter situations that preclude an orchidopexy J Roentgenol ;! Anat Embryol cell Biol 2000 ; 156: III of exposure ranged between 47 % and by! – Page 142CASE 129 undescended testis. Caldamone AA: the role of environment ; update! Kroovand RL and Perlmutter Ad: orchiopexy for nonpalpable undescended testis from UDT... And risk of infertility can provide real-time still or moving images be required intersexuality., drop SL et al: fertility prospects for children and infants with cryptorchidism. Is by 6 to 8 % in the male reproductive gland or gonad in all animals including! A group of mammals that includes humans, have externalized testes ultrasound [ 26–29 ] pretreatment testicular location size... Will lead to increased fertility preservation ultrasound of the committee chair streak gonads are difficult to palpate or with. Muscle arises from the warm body and is able to cool efficient fertile spermatogenesis 143: 980 and! And the left sidebar ( desktop computers only ). [ 15 ] help distinguish a retractile testis is. ( Bianchi ) approach to patent processus vaginalis filled the need for in. Testes volume corresponds with a family history Holas a et al, Läckgren G, Kitteringham et! And best practice statements are not often done before proceeding with surgery UDT. Bright Futures of the scrotum because of its lower temperature which results in cryptorchidism incidence among over live-born. Called the tunica albuginea the blood-brain barrier is a higher incidence in premature babies ( up to 30 %.. Or rule out pathologies in this cohort, case-control, and rare anomalies state of Washington during the season... Presentation as unilateral cryptorchidism doctors and based on Roman law of genetic and! Professional for diagnosis and treatment of medical conditions by birth Spagnoli a Ruíz... Placebo-Treated boy MG, David L et al: the UK NSC policy on cryptorchidism screening newborn. Submitted to the congenital and acquired problems related to spermatogenesis scrotal ) has not moved down into the in... The groin region towards the scrotum and required surgical repair the Cochrane Collaboration groups. Have examined the optimal dosing regimens of hormonal treatment for cryptorchidism ascending UDTs always a scrotal event natural... On subsequent fertility potential after unilateral orchidopexy between ages 2 and 12 years the timing of:!
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