Dear Editor,I would like to congratulate Mamsen et al.i on their extensive and scientifically valuable work.I analyzed their raw data presented in Table 1 of the original article from a different perspective and disco...Dear Editor,I would like to congratulate Mamsen et al.i on their extensive and scientifically valuable work.I analyzed their raw data presented in Table 1 of the original article from a different perspective and discovered an effect not mentioned in the article.My analysis showed that luteinizing hormone(LH)levels are significantly lower in patients at high infertility risk(HIR),whose testes lack A dark(Ad)spermatogonia and display an abnormal ratio of germ cells per crosssectional tubule(G/T).展开更多
Dear Editor,We are much obliged that Hadziselimovic1 has used our data2 to highlight the substantial proportion of boys with cryptorchidism where gonadotropin insufficiency is an important factor related to the pathog...Dear Editor,We are much obliged that Hadziselimovic1 has used our data2 to highlight the substantial proportion of boys with cryptorchidism where gonadotropin insufficiency is an important factor related to the pathogenesis.We have recently presented a study on a series of 453 consecutive boys with bilateral nonsyndromic cryptorchidism,in which we conducted hormonal evaluations and assessed germ cell numbers in testicular biopsies.3 In this series,45%of the boys were classified as having gonadotropin insufficiency.3 Identifying these patients at the time of surgery is important.A recent follow-up study of 208 boys with nonsyndromic bilateral cryptorchidism from our department showed that the boys with gonadotropin insufficiency had an impaired fertility potential after surgery compared to boys with an intact hypothalamus–pituitary–gonadal feedback mechanism.4 In a review from 2022,Hadziselimovic5 suggested that infertility in patients diagnosed with cryptorchid testes is a consequence of a hormonal deficiency rather than temperature-induced cellular damage.展开更多
Highlights●CRISPR/Cas9 RNP complex-based strategy demonstrates robustness and accuracy in generating gene-edited sheep.●Sheep horn development remains unaffected by partial RXFP2 knockout.●Partial RXFP2 knockout re...Highlights●CRISPR/Cas9 RNP complex-based strategy demonstrates robustness and accuracy in generating gene-edited sheep.●Sheep horn development remains unaffected by partial RXFP2 knockout.●Partial RXFP2 knockout results in unilateral cryptorchidism in sheep.展开更多
Aim: To investigate the relationship between germ cell degeneration and apoptosis in cryptorchid rats. Methods: Thirteen 21-day-old Wistar rats were made unilaterally cryptorchid by closing the left inguinal canal. At...Aim: To investigate the relationship between germ cell degeneration and apoptosis in cryptorchid rats. Methods: Thirteen 21-day-old Wistar rats were made unilaterally cryptorchid by closing the left inguinal canal. At day 30 (Group 1, n=6) and day 60 (Group 2, n=7) after operation, the testes were removed for histopathological examination. The controls (n=8) were sham operated and were sacrificed at day 60. Germ cell apoptosis was assessed by means of the TUNEL method. Results: Spermatogenesis was arrested and the testicular and seminiferous tubular diameters were significantly reduced In the unilateral undescended testes (UUTs) compared with the contralateral descended testes (CDTs) and the control rats. However, atrophic changes, pathological calcification, necrosis of seminiferous tubule, and absence or sloughing of germ cells were not found in all the animals. The spermatocytes were the main type of germ cells undergoing apoptosis in all the groups. In the UUTs, there was a significant and time-dependent increase in the mean apoptotic index. By 60 days after surgery, increased apoptosis in germ cells was also observed in the CDTs. Conclusion: Apoptosis is the predominant mechanism of germ cell death rather than atrophy and necrosis in cryptorchidism.展开更多
This study aimed to represent the recent trends in the nationwide incidence of cryptorchidism and hypospadias in Korea, and to determine whether there is evidence of spatial heterogeneity in the incidence. The inciden...This study aimed to represent the recent trends in the nationwide incidence of cryptorchidism and hypospadias in Korea, and to determine whether there is evidence of spatial heterogeneity in the incidence. The incidence was calculated as the number of newly diagnosed patients （males） during the first 4 years after a live birth in a population, nationally and regionally （a non-industrialized area （Chuncheon） and petrochemical estates （Yeocheon and Ulsan））, between 2000 and 2005. The data （numerator） for new patients were acquired from the National Health Insurance Review Agency, and the data （denominator） for the resident registration population were from the National Statistical Office. Between 2000 and 2005, the national incidence of cryptorchidism and hypospadias had an increased tendency from 5.01 to 17.43 per 10 000 persons and from 1.40 to 3.28 per 10 000 persons, respectively. The incidence of cryptorchidism was significantly higher in Yeocheon （throughout the study period） and in Ulsan （2001, 2002, 2004 and 2005） than the national incidence, whereas the incidence in Chuncheon was significantly lower in 2001 and 2002. It was difficult to compare the rates of hypospadias yearly and regionally because of the small number of cases. In conclusion, the incidence of cryptorchidism has recently increased in Korea. The petrochemical estates, Yeocheon and Ulsan, had a significantly higher incidence of cyptorchidism than the national incidence, which suggests that further study is needed to obtain a more precise estimation of the trends in the incidence of the anomalies and to confirm the association between petrochemicals and the anomalies.展开更多
Abdominal cocoon syndrome(ACS) is a rare cause of intestinal obstruction due to total or partial encapsulation of the small intestine by a fibrocollagenous membrane. Idiopathic ACS with abdominal cryptorchidism and gr...Abdominal cocoon syndrome(ACS) is a rare cause of intestinal obstruction due to total or partial encapsulation of the small intestine by a fibrocollagenous membrane. Idiopathic ACS with abdominal cryptorchidism and greater omentum hypoplasia is even rarer clinically. We successfully treated a 26-year-old male case of small bowel obstruction with acute peritonitis. He was finally diagnosed with idiopathic ACS with unilateral abdominal cryptorchidism and greater omentum hypoplasia during exploratory laparotomy. He then underwent enterolysis, cryptorchidectomy, and appendectomy. He recovered gradually from the operations and early postoperative inflammatory ileus. There has been no recurrence of intestinal obstruction since the operation, and he is still in follow-up. We analyzed his clinical data and retrospectively reviewed the literature, and our findings may be helpful for the clinical diagnosis and treatment on ACS.展开更多
Aim: To evaluate the long term effect of experimental cryptorchidism on germ cell apoptotic rate and testicular sperm content in adult rats. Methods: Bilateral cryptorchidism was created in 40 adult male Sprague-Dawle...Aim: To evaluate the long term effect of experimental cryptorchidism on germ cell apoptotic rate and testicular sperm content in adult rats. Methods: Bilateral cryptorchidism was created in 40 adult male Sprague-Dawley rats by surgically manipulating the testes into the abdominal cavity and closing the internal inguinal ring. The rats were sacrificed and the testes removed 6 hours and 2, 4, 7, 21, 28 and 56 days after cryptorchidism. Germ cell apoptosis was quantified by means of TUNEL assay and apoptosis was confirmed using transmission electron microscopy. Results: The rate of apoptosis peaked at 4 days of cryptorchidism and then progressively declined to a nadir at 14 days of cryptorchidism. At 56 days of cryptorchidism, the germinal epithelium was largely depleted by the apoptotic process and only a few mature sperm were seen within the testis. At this point, a few tubules were seen to be repopulating with primary spermatocytes and the level of germ cell apoptosis began to increase marginally. Testicular sperm count (TSC) began to decline rapidly at day 7 of cryptorchidism. Only a few mature sperm were found in the testes of rats following 56 days of cryptorchidism. Multinucleated giant cells (MGC) were most numerous within the seminiferous tubules at day 4. At day 7, 35 % of MGCs were TUNEL positive. At all subsequent time points, however, MGCs fail to stain positive for apoptosis. This resumption of increased apoptosis coincided with the appearance of a population of primary spermatocytes in some seminiferous tubules. Moreover, there was not a corresponding increase in the number of mature sperm after 56 days of cryptorchidism. Conclusion: The decline in germ cell apoptosis after 4 days of cryptorchidism can be attributed to be the result of an overall depletion of germ cells. It appears that after a prolonged cryptorchidism (56 days), there is a limited resumption of spermatogenesis presumably as a result of a decrease in the maturing germ cells undergoing programmed cell death.展开更多
Aim： To assess the spatiotemporal changes in the expression of extracellular signal-regulated kinases 1 and 2 （ERK1/ 2）, c-Jun N-terminal kinases （JNK） and p38 mitogen-activated protein kinases （MAPK） in respon...Aim： To assess the spatiotemporal changes in the expression of extracellular signal-regulated kinases 1 and 2 （ERK1/ 2）, c-Jun N-terminal kinases （JNK） and p38 mitogen-activated protein kinases （MAPK） in response to heat stress in the cryptorchid testis, and to investigate a possible relation to Sertoli cell dedifferentiation. Methods： Immunohistochemistry and western blot were used to examine the expression and activation of ERK1/2, p38 and JNK in the cryptorchid testis at various stages after experimental cryptorchidism. Results： The abdominal temperature did not obviously change the total ERK1/2 expression but significantly activated phospho-ERK1/2 in the Sertoli cells of the cryptorchid testis. Heat stress increased total JNK expression in the Sertoli cells of the cryptorchid testis but did not activate phospho-JNK. Neither total p38 nor phospho-p38 was induced by heat stress in the Sertoli cells of the cryptorchid testis. Changes in the spatiotemporal expression of cytokeratin 18 （CK18）, a marker of immature or undifferentiated Sertoli cells, were induced in the cryptorchid testis in a pattern similar to the activation of ERK1/2. Condusion： The activation of ERK1/2 in the testis may be related to dedifferentiation of Sertoli cells under heat stress induced by experimental cryptorchidism.展开更多
Cryptorchidism is one of the most frequent causes of nonobstructive azoospermia(NOA)in adulthood.Although it is well known that spermatogenesis is more impaired in bilateral than in unilateral cryptorchidism,previous ...Cryptorchidism is one of the most frequent causes of nonobstructive azoospermia(NOA)in adulthood.Although it is well known that spermatogenesis is more impaired in bilateral than in unilateral cryptorchidism,previous studies have only described small cohorts or inhomogeneous population.Consequently,we analyzed a cohort of 225 men with only a history of cryptorchidism as sole etiopathogenetic factor for NOA,and compared testicular sperm extraction(TESE)outcomes between men with bilateral versus unilateral cryptorchidism.Our results show no difference in follicle-stimulating hormone(FSH)levels and testicular volumes between men with a history of bilateral cryptorchidism compared to unilateral cryptorchidism(median:21.3 IU I^-1 vs 19.3 IU I^-1,P=0.306;and 7.2 ml vs 7.9 ml,P=0.543,respectively).In addition,sperm retrieval rates were similar(66.2%vs 60.0%,P=0.353).Using multivariate analysis,we have found that only a low inhibin B level(above the assay's detection limit)was positively associated with successful sperm retrieval(P<0.05).Regarding intracytoplasmic sperm injection outcomes,we found that cumulative pregnancy rate and live birth rate per cycle were not statistically different between the two groups(17.4%vs 27.8%,P=0.070;and 16.1%vs 26.4%,P=0.067,respectively).Unexpectedly,there was no significant difference in hormonal profiles(FSH,luteinizing hormone[LH],testosterone,and inhibin B levels)and TESE outcomes between unilateral versus bilateral cryptorchidism.This suggests that a history of unilateral cryptorchidism could reflect a bilateral testicular impairment.Interestingly,inhibin B level might be a predictor of successful TESE.展开更多
We investigated the associations of clinical and socioeconomic factors with delayed orchidopexy for cryptorchidism in China. A retrospective study was conducted on cryptorchid boys who underwent orchidopexy at Childre...We investigated the associations of clinical and socioeconomic factors with delayed orchidopexy for cryptorchidism in China. A retrospective study was conducted on cryptorchid boys who underwent orchidopexy at Children's Hospital at Chongqing Medical University in China from January 2012 to December 2017. Of 2423 patients, 410 (16.9%) received timely repair by 18 months of age, beyond which surgery was considered delayed. Univariate analysis suggested that the laterality of cryptorchidism (P = 0.001), comorbidities including inguinal hernia/scrotal hydrocele (P < 0.001) or urinary tract disease (P = 0.016), and whether patients lived in a poverty county (P < 0.001) could influence whether orchidopexy was timely or delayed. Logistic regression analysis suggested that the following factors were associated with delayed repair: unilateral rather than bilateral cryptorchidism (odds ratio [OR]= 1.752, P < 0.001), absence of inguinal hernia or hydrocele (OR = 2.027, P = 0.019), absence of urinary tract disease (OR = 3.712, P < 0.001), and living in a poverty county (OR = 2.005, P < 0.001). The duration of postoperative hospital stay and hospital costs increased with the patient's age at the time of surgery.展开更多
Aim： To investigate whether estrogen stimulates the proliferation of spermatogonia or induces spermatogenesis in cryptorchid mice. Methods： Mice were surgically rendered cryptorchid, then treated with different dose...Aim： To investigate whether estrogen stimulates the proliferation of spermatogonia or induces spermatogenesis in cryptorchid mice. Methods： Mice were surgically rendered cryptorchid, then treated with different doses of 17β- estradiol （E2） s.c. once a day. Mice were killed at sexual maturity （45 days of age）, and histological analysis and inununofluorescence were performed. Serum follicle stimulating hormone （FSH）, estradiol, testosterone and luteinizing hormone （LH） were measured. Results： Low doses of E2 had no notable effect on spermatogonia, but at higher doses, E2 stimulated the proliferation of spermatogonia. Conclusion： E2 has a dose-related mitogenic effect on spermatogonia.展开更多
Pubertal development may be altered in boys with cryptorchidism and hypospadias,but existing kno wledge is inc on siste nt.Therefore,we investigated the association between cryptorchidism and hypospadias and pubertal ...Pubertal development may be altered in boys with cryptorchidism and hypospadias,but existing kno wledge is inc on siste nt.Therefore,we investigated the association between cryptorchidism and hypospadias and pubertal development in a large cohort study.Boys in the Puberty Cohort,a cohort nested within the Danish National Birth Cohort,were in eluded in this study.Information on cryptorchidism and hypospadias was retrieved from the Danish National Patient Register.From 11 years until 18 years or full pubertal developme nt,info rmatio n on physical markers of pubertal developme nt was provided biannu ally,in eluding Tanner stages,axillary hair,acne,voice break,and first ejaculation.In multivariate regression models for interval censored data,the mean(95%confidence intervals[Cis])d iff ere nces in months in obtaining the pubertal markers between boys with and without the anomalies were estimated.Among 7698 boys,196(2.5%)had cryptorchidism and 60(0.8%)had hypospadias.Boys with hypospadias experienced first ejaculation and voice break 7.7(95%Cl:2.5-13.0)months and 4.5(95%Cl:0.3-8.7)months later than boys without hypospadias?The age at attaining the Tanner stages for gonadal and pubic hair growth was also higher,though not statistically significant.Pubertal development seemed unaffected in boys with mild as well as severe cryptorchidism?In conclusion,hypospadias may be associated with delayed pubertal development,but pubertal development seems unaffected by cryptorchidism.The relation between hypospadias and later pubertal development may be due to the underlying shared in utero risk or genetic factors.展开更多
This study aimed to review and compare the characteristics and treatment outcomes of cryptorchid testicular torsion in pre-and postpubertal children.We reviewed the clinical data of 22 patients with testicular torsion...This study aimed to review and compare the characteristics and treatment outcomes of cryptorchid testicular torsion in pre-and postpubertal children.We reviewed the clinical data of 22 patients with testicular torsion complicated by cryptorchidism who were treated between January 2010 and December 2019.Patients were categorized into prepubertal(1 month to 9 years;n=12)and postpubertal groups(10-16 years;n=10).The age at presentation,clinical presentations,physical examination,and operation outcomes were assessed.The common clinical presentations in both groups were inguinal pain and a tender inguinal mass.Patients in the prepubertal group were significantly more likely to present with restlessness(33.3%)than those in the postpubertal group(0%;P-0.044).After detorsion,testicular blood flow recovered during surgery in 25.0%of the prepubertal and 80.0%of the postpubertal patients(P=0.010).Orchiectomy was required in 50.0%of the prepubertal and 20.0%of the postpubertal patients(P=0.145).Of the 22 patients with follow-up data,the rates of testicular salvage were significantly different,at 16.7%in the prepubertal patients and 60.0%in the postpubertal patients(P=0.035).Cryptorchid testicular torsion has various manifestations.Although an empty hemiscrotum and a painful groin mass were common in both groups,restlessness was more prevalent in the prepubertal patients during early testicular torsion onset than that in the postpubertal patients.Notably,the testicular salvage rate was significantly lower in the prepubertal patients than that in the postpubertal patients.展开更多
AIM: To explore the changes of epidermal growth factor (EGF) and epidermal growth factor receptor (EGFR) expressions in cryptorchid children and their clinical significance. METHODS: The level of serum EGF was measure...AIM: To explore the changes of epidermal growth factor (EGF) and epidermal growth factor receptor (EGFR) expressions in cryptorchid children and their clinical significance. METHODS: The level of serum EGF was measured by radioimmunoassay (RIA) and the expression of EGFR by immunohistochemistry. RESULTS: (1) The level of serum EGF was significantly lower in cryptorchid children than in normal subjects at age group of 5-9 years (P展开更多
Autophagy is invoIved in spermatogenesis by regulating germ cell maturation.This catabolic process increases with hyperthermic conditions to prevent the accumulation of damaged organelles.Cryptorchidism is associated ...Autophagy is invoIved in spermatogenesis by regulating germ cell maturation.This catabolic process increases with hyperthermic conditions to prevent the accumulation of damaged organelles.Cryptorchidism is associated with impairment of germ cell maturation revealed by the presence of immature forms of sperm cells in ejaculates.The aim of the present study was to evaluate the status of autophagy in sperm cells from cryptorchid patients.Semen samples of cryptorchid patients and normozoospermic controls were analyzed by immuno cytochemistry and electron microscopy.Autophagy protei ns,autophagy-related protein 9(ATG9)and microtubule-associated protein,lA/lB-light chain 3(LC3)were localized by immunocytochemistry on the acrosome and on the equatorial segment of sperm cells.LC3 was also detected in the midpiece of cryptorchid sperm tail.Autophagy substrate p62 protein was present in the acrosome and in the postequatorial segment of sperm in control samples,but not in the cryptorchid ones.Transmission electron microscopy revealed double-membrane-limited autophagosomes in postequatorial part of spermatozoa head and midpiece in cryptorchid samples.Partly degraded mitochondria were frequently discerned in autophagic vacuoles.In conclusion,autophagy is increased in sperm cells from patients with cryptorchid history comparatively to control.Our work provides insights into the role of autophagy in the maturation and survival of human male gametes in pathological conditions.Thus,regulating autophagy could represent a potential way to improve sperm quality in cryptorchid men.展开更多
This study was performed to summarize our clinical experience with testicular descent and fixation through a scrotal stria incision for the treatment of palpable cryptorchidism in children.This study included 1034 chi...This study was performed to summarize our clinical experience with testicular descent and fixation through a scrotal stria incision for the treatment of palpable cryptorchidism in children.This study included 1034 children with palpable cryptorchidism from March 2009 to March 2019.A scrotal stria incision was used to perform testicular descent and fixation.Overall,1020 children successfully underwent surgical testicular descent and fixation through a scrotal stria incision,and 14 patients underwent conversion to inguinal incision surgery.All patients were discharged 1-2 days after the operation.During hospitalization and follow-up,55 patients developed complicationsy including 10 patients with testicular retraction,7 with poor healing of the incision,and 38 with a scrotal hematoma.No patients developed testicular atrophy,an in direct ingui nal hernia,or a hydrocoele.Testicular descent and fixation through a scrotal stria incision for the treatment of palpable cryptorchidism in children is safe and feasible in well-selected cases.This method has the advantages of no scarring and a good cosmetic effect.展开更多
We describe and summarize the diagnosis,treatment,and reasons for delayed treatment of children with cryptorchidism torsion in Children's Hospital of Chongqing Medical University.The study included 19 cases of cry...We describe and summarize the diagnosis,treatment,and reasons for delayed treatment of children with cryptorchidism torsion in Children's Hospital of Chongqing Medical University.The study included 19 cases of cryptorchidism torsion.The age of the children ranged from 16 days to 12 years(median:6 years).The interval from diagnosis to surgery varied from 4 h to 16 days(median:3 days).Ultrasound was performed in all cases.Fifteen cases had cryptorchidism torsion,2 cases had a soft tissue mass in the inguinal region,and 2 cases had an inguinal/abdominal teratoma.Five cases were treated with an orchidopexy,12 cases were treated with orchiectomy,and 2 cases received resection of a testicular tumor.The 5 children with an orchidopexy were followed up from 1 month to 7 years(median:3 years),with 1 child having a testis retraction and no blood supply.Of the 12 children who had an orchiectomy,three had delayed diagnosis due to family unawareness of the condition,while other delays were due to delayed referral from primary care facilities.The relative rarity and insufficient awareness of cryptorchidism torsion resulted in a low rate of testicular salvage.Therefore,hospitals of all levels should be fully aware of cryptorchidism with torsion and ensure a male child's genital system and inguinal region are examined to improve the success rate of testicular salvage.展开更多
Cryptorchidism affects the growth of testicular volume.Testicular volume is associated with reproductive function.The testicular atrophy index evaluates the degree of damage caused by cryptorchidism,but it remains unc...Cryptorchidism affects the growth of testicular volume.Testicular volume is associated with reproductive function.The testicular atrophy index evaluates the degree of damage caused by cryptorchidism,but it remains unclear whether changes in testicular atrophy index are related to age.We selected patients who underwent surgery for unilateral palpable cryptorchidism.Testicular volume was measured using ultrasonography.The testicular atrophy indices of the undescended testes were then reviewed,and their correlation with age was analyzed.We studied 228 cases(age range:6–53 months).Scatter plots were constructed,and Loess curves were fitted,revealing a turning point at 24 months of age.The patients were divided into age groups of 6–24 months and 25–53 months.The testicular volume of the cryptorchid side was smaller than that of the normal side in both groups(both P<0.001).In the 6–24-month group,the testicular atrophy index was positively correlated with age,testicular volume on the cryptorchid side was not correlated with age,and testicular volume was positively correlated with age on the normal side.In the 25–53-month group,testicular atrophy index and testicular volumes on either side were not correlated with age.A palpable unilateral cryptorchid testis is smaller than the contralateral testis.The testicular atrophy index increases with age between 6 months and 24 months,but not between 25 months and 53 months.Testicular volume increased with age on the normal side between 6 months and 24 months,but not on the cryptorchid side.Trends in testicular atrophy index with age contribute to the decision of operation time.展开更多
This study aims to explore the factors influencing the success rate of the microdissection testicular sperm extraction(Micro-TESE)in patients with nonobstructive azoospermia(NOA)and cryptorchidism.Clinical data of 162...This study aims to explore the factors influencing the success rate of the microdissection testicular sperm extraction(Micro-TESE)in patients with nonobstructive azoospermia(NOA)and cryptorchidism.Clinical data of 162 patients with cryptorchidism who underwent Micro-TESE due to infertility from December 2015 to May 2020 in the First Affiliated Hospital of Nanjing Medical University were analyzed retrospectively.In the univariate analysis,significant differences in the age of patient at the time of orchidopexy(median[interquartile range,IQR]:7.0[4.0–11.0]years vs 11.5[9.0–14.5]years,P<0.001),interval between orchidopexy and Micro-TESE(mean±standard deviation:17.5±5.0 years vs 14.4±4.4 years,P<0.001),severity of cryptorchidism(unilateral[62.8%]vs bilateral[31.6%],P<0.001;location of cryptorchidism,intra-abdominal[27.3%]vs inguinal[44.8%]vs suprascrotal[66.7%],P<0.001),volume of the dominant testis(median[IQR]:17.00[15.00–19.00]ml vs 14.50[11.75–16.25]ml,P<0.001),and levels of follicle-stimulating hormone(FSH;P=0.004)and testosterone(P=0.006)were observed between the successful and failed sperm extraction groups.After conducting the multivariate analysis,four of these factors,including unilateral/bilateral cryptorchidism(P<0.001),location of cryptorchidism(P=0.032),age of orchidopexy(P<0.001),and dominant testicular volume,were adopted in the clinical prediction model to evaluate preoperatively the success rate of Micro-TESE for patients with NOA and cryptorchidism.The likelihood of successful sperm retrieval by Micro-TESE in men with NOA and cryptorchidism increased in patients with mild forms of cryptorchidism.展开更多
Cryptorchidism is associated with infertility in adulthood.Early orchiopexy is suggested to reduce the risk.Information is lacking on the potential link between infant germ cell maturation and the risk of future infer...Cryptorchidism is associated with infertility in adulthood.Early orchiopexy is suggested to reduce the risk.Information is lacking on the potential link between infant germ cell maturation and the risk of future infertility.The objective of the study was to evaluate age-related germ cell development in cryptorchidism.Immunostaining for markers of germ cell development(octamerbinding transcription factor 3/4[0CT3/4],placental alkaline phosphatase[PLAP],KIT proto-oncogene[C-KIT],podoplanin[D2-40],Lin-28 homolog A[LIN28],and G antigen 7[GAGE-7])was performed in testicular biopsies from 40 cryptorchid boys aged 4-35 mon ths.Germ cell nu mbers and distributi ons were evaluated in cross sectio ns of semi niferous tubules,with and without immuno staini ng.OCT3/4,D2-40,and LIN 28 were gen erally expressed in the early stages of germ cell development,as show n by positive expression in germ cells in the central region of seminiferous tubules・In contrast,PLAP and GAGE-7 were expressed in both central and peripheral parts of the tubules in the early stages of development and expressed mainly in a peripheral position with advancing age.Germ cell maturation was delayed in this study population as compared with that observed in our previous study on germ cell markers in a healthy population.The number of GAGE-7-positive germ cells per tubular cross section obtained by immunostaining was significantly higher than that obtained by standard hematoxylin and eosin staining.Double immunostaining revealed heterogeneity in germ cell development in cryptorchid testes.These results shed light on the pathophysiology of germ cell development in boys with cryptorchidism.展开更多
文摘Dear Editor,I would like to congratulate Mamsen et al.i on their extensive and scientifically valuable work.I analyzed their raw data presented in Table 1 of the original article from a different perspective and discovered an effect not mentioned in the article.My analysis showed that luteinizing hormone(LH)levels are significantly lower in patients at high infertility risk(HIR),whose testes lack A dark(Ad)spermatogonia and display an abnormal ratio of germ cells per crosssectional tubule(G/T).
文摘Dear Editor,We are much obliged that Hadziselimovic1 has used our data2 to highlight the substantial proportion of boys with cryptorchidism where gonadotropin insufficiency is an important factor related to the pathogenesis.We have recently presented a study on a series of 453 consecutive boys with bilateral nonsyndromic cryptorchidism,in which we conducted hormonal evaluations and assessed germ cell numbers in testicular biopsies.3 In this series,45%of the boys were classified as having gonadotropin insufficiency.3 Identifying these patients at the time of surgery is important.A recent follow-up study of 208 boys with nonsyndromic bilateral cryptorchidism from our department showed that the boys with gonadotropin insufficiency had an impaired fertility potential after surgery compared to boys with an intact hypothalamus–pituitary–gonadal feedback mechanism.4 In a review from 2022,Hadziselimovic5 suggested that infertility in patients diagnosed with cryptorchid testes is a consequence of a hormonal deficiency rather than temperature-induced cellular damage.
基金supported by the National Key Research and Development Program of China(2022YFD1300200)the National Natural Science Foundation of China(32161143010,32202646,and 32272848)+2 种基金the China Agriculture Research System(CARS-39)the Key Special Project of Ningxia Science and Technology Department,China(2021BEF02024)the local grants,China(NXTS2021-001,2022GD-TSLD-46,NK2022010207,and NXTS2022-001)。
文摘Highlights●CRISPR/Cas9 RNP complex-based strategy demonstrates robustness and accuracy in generating gene-edited sheep.●Sheep horn development remains unaffected by partial RXFP2 knockout.●Partial RXFP2 knockout results in unilateral cryptorchidism in sheep.
文摘Aim: To investigate the relationship between germ cell degeneration and apoptosis in cryptorchid rats. Methods: Thirteen 21-day-old Wistar rats were made unilaterally cryptorchid by closing the left inguinal canal. At day 30 (Group 1, n=6) and day 60 (Group 2, n=7) after operation, the testes were removed for histopathological examination. The controls (n=8) were sham operated and were sacrificed at day 60. Germ cell apoptosis was assessed by means of the TUNEL method. Results: Spermatogenesis was arrested and the testicular and seminiferous tubular diameters were significantly reduced In the unilateral undescended testes (UUTs) compared with the contralateral descended testes (CDTs) and the control rats. However, atrophic changes, pathological calcification, necrosis of seminiferous tubule, and absence or sloughing of germ cells were not found in all the animals. The spermatocytes were the main type of germ cells undergoing apoptosis in all the groups. In the UUTs, there was a significant and time-dependent increase in the mean apoptotic index. By 60 days after surgery, increased apoptosis in germ cells was also observed in the CDTs. Conclusion: Apoptosis is the predominant mechanism of germ cell death rather than atrophy and necrosis in cryptorchidism.
文摘This study aimed to represent the recent trends in the nationwide incidence of cryptorchidism and hypospadias in Korea, and to determine whether there is evidence of spatial heterogeneity in the incidence. The incidence was calculated as the number of newly diagnosed patients （males） during the first 4 years after a live birth in a population, nationally and regionally （a non-industrialized area （Chuncheon） and petrochemical estates （Yeocheon and Ulsan））, between 2000 and 2005. The data （numerator） for new patients were acquired from the National Health Insurance Review Agency, and the data （denominator） for the resident registration population were from the National Statistical Office. Between 2000 and 2005, the national incidence of cryptorchidism and hypospadias had an increased tendency from 5.01 to 17.43 per 10 000 persons and from 1.40 to 3.28 per 10 000 persons, respectively. The incidence of cryptorchidism was significantly higher in Yeocheon （throughout the study period） and in Ulsan （2001, 2002, 2004 and 2005） than the national incidence, whereas the incidence in Chuncheon was significantly lower in 2001 and 2002. It was difficult to compare the rates of hypospadias yearly and regionally because of the small number of cases. In conclusion, the incidence of cryptorchidism has recently increased in Korea. The petrochemical estates, Yeocheon and Ulsan, had a significantly higher incidence of cyptorchidism than the national incidence, which suggests that further study is needed to obtain a more precise estimation of the trends in the incidence of the anomalies and to confirm the association between petrochemicals and the anomalies.
基金Supported by Major Projects of Chinese PLA"13~(th) Five-Year Plan" Logistics Research Subject,No.AKJ15J003
文摘Abdominal cocoon syndrome(ACS) is a rare cause of intestinal obstruction due to total or partial encapsulation of the small intestine by a fibrocollagenous membrane. Idiopathic ACS with abdominal cryptorchidism and greater omentum hypoplasia is even rarer clinically. We successfully treated a 26-year-old male case of small bowel obstruction with acute peritonitis. He was finally diagnosed with idiopathic ACS with unilateral abdominal cryptorchidism and greater omentum hypoplasia during exploratory laparotomy. He then underwent enterolysis, cryptorchidectomy, and appendectomy. He recovered gradually from the operations and early postoperative inflammatory ileus. There has been no recurrence of intestinal obstruction since the operation, and he is still in follow-up. We analyzed his clinical data and retrospectively reviewed the literature, and our findings may be helpful for the clinical diagnosis and treatment on ACS.
文摘Aim: To evaluate the long term effect of experimental cryptorchidism on germ cell apoptotic rate and testicular sperm content in adult rats. Methods: Bilateral cryptorchidism was created in 40 adult male Sprague-Dawley rats by surgically manipulating the testes into the abdominal cavity and closing the internal inguinal ring. The rats were sacrificed and the testes removed 6 hours and 2, 4, 7, 21, 28 and 56 days after cryptorchidism. Germ cell apoptosis was quantified by means of TUNEL assay and apoptosis was confirmed using transmission electron microscopy. Results: The rate of apoptosis peaked at 4 days of cryptorchidism and then progressively declined to a nadir at 14 days of cryptorchidism. At 56 days of cryptorchidism, the germinal epithelium was largely depleted by the apoptotic process and only a few mature sperm were seen within the testis. At this point, a few tubules were seen to be repopulating with primary spermatocytes and the level of germ cell apoptosis began to increase marginally. Testicular sperm count (TSC) began to decline rapidly at day 7 of cryptorchidism. Only a few mature sperm were found in the testes of rats following 56 days of cryptorchidism. Multinucleated giant cells (MGC) were most numerous within the seminiferous tubules at day 4. At day 7, 35 % of MGCs were TUNEL positive. At all subsequent time points, however, MGCs fail to stain positive for apoptosis. This resumption of increased apoptosis coincided with the appearance of a population of primary spermatocytes in some seminiferous tubules. Moreover, there was not a corresponding increase in the number of mature sperm after 56 days of cryptorchidism. Conclusion: The decline in germ cell apoptosis after 4 days of cryptorchidism can be attributed to be the result of an overall depletion of germ cells. It appears that after a prolonged cryptorchidism (56 days), there is a limited resumption of spermatogenesis presumably as a result of a decrease in the maturing germ cells undergoing programmed cell death.
基金Acknowledgment This study was supported by the National Natural Science Foundation of China （30230190）, the National Basic Science Research and Development Project （973） （G1999055901） and the Chinese Academy of Sciences （CAS） Knowledge Innovation Program （KSCX-2-SW-201）.
文摘Aim： To assess the spatiotemporal changes in the expression of extracellular signal-regulated kinases 1 and 2 （ERK1/ 2）, c-Jun N-terminal kinases （JNK） and p38 mitogen-activated protein kinases （MAPK） in response to heat stress in the cryptorchid testis, and to investigate a possible relation to Sertoli cell dedifferentiation. Methods： Immunohistochemistry and western blot were used to examine the expression and activation of ERK1/2, p38 and JNK in the cryptorchid testis at various stages after experimental cryptorchidism. Results： The abdominal temperature did not obviously change the total ERK1/2 expression but significantly activated phospho-ERK1/2 in the Sertoli cells of the cryptorchid testis. Heat stress increased total JNK expression in the Sertoli cells of the cryptorchid testis but did not activate phospho-JNK. Neither total p38 nor phospho-p38 was induced by heat stress in the Sertoli cells of the cryptorchid testis. Changes in the spatiotemporal expression of cytokeratin 18 （CK18）, a marker of immature or undifferentiated Sertoli cells, were induced in the cryptorchid testis in a pattern similar to the activation of ERK1/2. Condusion： The activation of ERK1/2 in the testis may be related to dedifferentiation of Sertoli cells under heat stress induced by experimental cryptorchidism.
文摘Cryptorchidism is one of the most frequent causes of nonobstructive azoospermia(NOA)in adulthood.Although it is well known that spermatogenesis is more impaired in bilateral than in unilateral cryptorchidism,previous studies have only described small cohorts or inhomogeneous population.Consequently,we analyzed a cohort of 225 men with only a history of cryptorchidism as sole etiopathogenetic factor for NOA,and compared testicular sperm extraction(TESE)outcomes between men with bilateral versus unilateral cryptorchidism.Our results show no difference in follicle-stimulating hormone(FSH)levels and testicular volumes between men with a history of bilateral cryptorchidism compared to unilateral cryptorchidism(median:21.3 IU I^-1 vs 19.3 IU I^-1,P=0.306;and 7.2 ml vs 7.9 ml,P=0.543,respectively).In addition,sperm retrieval rates were similar(66.2%vs 60.0%,P=0.353).Using multivariate analysis,we have found that only a low inhibin B level(above the assay's detection limit)was positively associated with successful sperm retrieval(P<0.05).Regarding intracytoplasmic sperm injection outcomes,we found that cumulative pregnancy rate and live birth rate per cycle were not statistically different between the two groups(17.4%vs 27.8%,P=0.070;and 16.1%vs 26.4%,P=0.067,respectively).Unexpectedly,there was no significant difference in hormonal profiles(FSH,luteinizing hormone[LH],testosterone,and inhibin B levels)and TESE outcomes between unilateral versus bilateral cryptorchidism.This suggests that a history of unilateral cryptorchidism could reflect a bilateral testicular impairment.Interestingly,inhibin B level might be a predictor of successful TESE.
基金the National Natural Science Foundation of China (Grant No. 81571425).
文摘We investigated the associations of clinical and socioeconomic factors with delayed orchidopexy for cryptorchidism in China. A retrospective study was conducted on cryptorchid boys who underwent orchidopexy at Children's Hospital at Chongqing Medical University in China from January 2012 to December 2017. Of 2423 patients, 410 (16.9%) received timely repair by 18 months of age, beyond which surgery was considered delayed. Univariate analysis suggested that the laterality of cryptorchidism (P = 0.001), comorbidities including inguinal hernia/scrotal hydrocele (P < 0.001) or urinary tract disease (P = 0.016), and whether patients lived in a poverty county (P < 0.001) could influence whether orchidopexy was timely or delayed. Logistic regression analysis suggested that the following factors were associated with delayed repair: unilateral rather than bilateral cryptorchidism (odds ratio [OR]= 1.752, P < 0.001), absence of inguinal hernia or hydrocele (OR = 2.027, P = 0.019), absence of urinary tract disease (OR = 3.712, P < 0.001), and living in a poverty county (OR = 2.005, P < 0.001). The duration of postoperative hospital stay and hospital costs increased with the patient's age at the time of surgery.
基金Acknowledgment This work was supported by the National Natural Science Foundation of China （No. 30200195）. We thank Dr Hai-Bin Wang for taking photographs and Dr Su-Hui Wu （Henan Normal University, China） for statistical analysis. We thank the faculty of Huanghuai University for supporting Dr En-Zhong Li.
文摘Aim： To investigate whether estrogen stimulates the proliferation of spermatogonia or induces spermatogenesis in cryptorchid mice. Methods： Mice were surgically rendered cryptorchid, then treated with different doses of 17β- estradiol （E2） s.c. once a day. Mice were killed at sexual maturity （45 days of age）, and histological analysis and inununofluorescence were performed. Serum follicle stimulating hormone （FSH）, estradiol, testosterone and luteinizing hormone （LH） were measured. Results： Low doses of E2 had no notable effect on spermatogonia, but at higher doses, E2 stimulated the proliferation of spermatogonia. Conclusion： E2 has a dose-related mitogenic effect on spermatogonia.
文摘Pubertal development may be altered in boys with cryptorchidism and hypospadias,but existing kno wledge is inc on siste nt.Therefore,we investigated the association between cryptorchidism and hypospadias and pubertal development in a large cohort study.Boys in the Puberty Cohort,a cohort nested within the Danish National Birth Cohort,were in eluded in this study.Information on cryptorchidism and hypospadias was retrieved from the Danish National Patient Register.From 11 years until 18 years or full pubertal developme nt,info rmatio n on physical markers of pubertal developme nt was provided biannu ally,in eluding Tanner stages,axillary hair,acne,voice break,and first ejaculation.In multivariate regression models for interval censored data,the mean(95%confidence intervals[Cis])d iff ere nces in months in obtaining the pubertal markers between boys with and without the anomalies were estimated.Among 7698 boys,196(2.5%)had cryptorchidism and 60(0.8%)had hypospadias.Boys with hypospadias experienced first ejaculation and voice break 7.7(95%Cl:2.5-13.0)months and 4.5(95%Cl:0.3-8.7)months later than boys without hypospadias?The age at attaining the Tanner stages for gonadal and pubic hair growth was also higher,though not statistically significant.Pubertal development seemed unaffected in boys with mild as well as severe cryptorchidism?In conclusion,hypospadias may be associated with delayed pubertal development,but pubertal development seems unaffected by cryptorchidism.The relation between hypospadias and later pubertal development may be due to the underlying shared in utero risk or genetic factors.
文摘This study aimed to review and compare the characteristics and treatment outcomes of cryptorchid testicular torsion in pre-and postpubertal children.We reviewed the clinical data of 22 patients with testicular torsion complicated by cryptorchidism who were treated between January 2010 and December 2019.Patients were categorized into prepubertal(1 month to 9 years;n=12)and postpubertal groups(10-16 years;n=10).The age at presentation,clinical presentations,physical examination,and operation outcomes were assessed.The common clinical presentations in both groups were inguinal pain and a tender inguinal mass.Patients in the prepubertal group were significantly more likely to present with restlessness(33.3%)than those in the postpubertal group(0%;P-0.044).After detorsion,testicular blood flow recovered during surgery in 25.0%of the prepubertal and 80.0%of the postpubertal patients(P=0.010).Orchiectomy was required in 50.0%of the prepubertal and 20.0%of the postpubertal patients(P=0.145).Of the 22 patients with follow-up data,the rates of testicular salvage were significantly different,at 16.7%in the prepubertal patients and 60.0%in the postpubertal patients(P=0.035).Cryptorchid testicular torsion has various manifestations.Although an empty hemiscrotum and a painful groin mass were common in both groups,restlessness was more prevalent in the prepubertal patients during early testicular torsion onset than that in the postpubertal patients.Notably,the testicular salvage rate was significantly lower in the prepubertal patients than that in the postpubertal patients.
文摘AIM: To explore the changes of epidermal growth factor (EGF) and epidermal growth factor receptor (EGFR) expressions in cryptorchid children and their clinical significance. METHODS: The level of serum EGF was measured by radioimmunoassay (RIA) and the expression of EGFR by immunohistochemistry. RESULTS: (1) The level of serum EGF was significantly lower in cryptorchid children than in normal subjects at age group of 5-9 years (P
文摘Autophagy is invoIved in spermatogenesis by regulating germ cell maturation.This catabolic process increases with hyperthermic conditions to prevent the accumulation of damaged organelles.Cryptorchidism is associated with impairment of germ cell maturation revealed by the presence of immature forms of sperm cells in ejaculates.The aim of the present study was to evaluate the status of autophagy in sperm cells from cryptorchid patients.Semen samples of cryptorchid patients and normozoospermic controls were analyzed by immuno cytochemistry and electron microscopy.Autophagy protei ns,autophagy-related protein 9(ATG9)and microtubule-associated protein,lA/lB-light chain 3(LC3)were localized by immunocytochemistry on the acrosome and on the equatorial segment of sperm cells.LC3 was also detected in the midpiece of cryptorchid sperm tail.Autophagy substrate p62 protein was present in the acrosome and in the postequatorial segment of sperm in control samples,but not in the cryptorchid ones.Transmission electron microscopy revealed double-membrane-limited autophagosomes in postequatorial part of spermatozoa head and midpiece in cryptorchid samples.Partly degraded mitochondria were frequently discerned in autophagic vacuoles.In conclusion,autophagy is increased in sperm cells from patients with cryptorchid history comparatively to control.Our work provides insights into the role of autophagy in the maturation and survival of human male gametes in pathological conditions.Thus,regulating autophagy could represent a potential way to improve sperm quality in cryptorchid men.
文摘This study was performed to summarize our clinical experience with testicular descent and fixation through a scrotal stria incision for the treatment of palpable cryptorchidism in children.This study included 1034 children with palpable cryptorchidism from March 2009 to March 2019.A scrotal stria incision was used to perform testicular descent and fixation.Overall,1020 children successfully underwent surgical testicular descent and fixation through a scrotal stria incision,and 14 patients underwent conversion to inguinal incision surgery.All patients were discharged 1-2 days after the operation.During hospitalization and follow-up,55 patients developed complicationsy including 10 patients with testicular retraction,7 with poor healing of the incision,and 38 with a scrotal hematoma.No patients developed testicular atrophy,an in direct ingui nal hernia,or a hydrocoele.Testicular descent and fixation through a scrotal stria incision for the treatment of palpable cryptorchidism in children is safe and feasible in well-selected cases.This method has the advantages of no scarring and a good cosmetic effect.
基金supported by the Basic Research and Frontier Exploration Project of Chongqing Science and Technology Bureau of Yuzhong District(No.20200151).
文摘We describe and summarize the diagnosis,treatment,and reasons for delayed treatment of children with cryptorchidism torsion in Children's Hospital of Chongqing Medical University.The study included 19 cases of cryptorchidism torsion.The age of the children ranged from 16 days to 12 years(median:6 years).The interval from diagnosis to surgery varied from 4 h to 16 days(median:3 days).Ultrasound was performed in all cases.Fifteen cases had cryptorchidism torsion,2 cases had a soft tissue mass in the inguinal region,and 2 cases had an inguinal/abdominal teratoma.Five cases were treated with an orchidopexy,12 cases were treated with orchiectomy,and 2 cases received resection of a testicular tumor.The 5 children with an orchidopexy were followed up from 1 month to 7 years(median:3 years),with 1 child having a testis retraction and no blood supply.Of the 12 children who had an orchiectomy,three had delayed diagnosis due to family unawareness of the condition,while other delays were due to delayed referral from primary care facilities.The relative rarity and insufficient awareness of cryptorchidism torsion resulted in a low rate of testicular salvage.Therefore,hospitals of all levels should be fully aware of cryptorchidism with torsion and ensure a male child's genital system and inguinal region are examined to improve the success rate of testicular salvage.
基金funded by the Medical Science and Technology Research Project of Henan Province provided by the Health Commission of Henan Province(No.LHGJ20190383).
文摘Cryptorchidism affects the growth of testicular volume.Testicular volume is associated with reproductive function.The testicular atrophy index evaluates the degree of damage caused by cryptorchidism,but it remains unclear whether changes in testicular atrophy index are related to age.We selected patients who underwent surgery for unilateral palpable cryptorchidism.Testicular volume was measured using ultrasonography.The testicular atrophy indices of the undescended testes were then reviewed,and their correlation with age was analyzed.We studied 228 cases(age range:6–53 months).Scatter plots were constructed,and Loess curves were fitted,revealing a turning point at 24 months of age.The patients were divided into age groups of 6–24 months and 25–53 months.The testicular volume of the cryptorchid side was smaller than that of the normal side in both groups(both P<0.001).In the 6–24-month group,the testicular atrophy index was positively correlated with age,testicular volume on the cryptorchid side was not correlated with age,and testicular volume was positively correlated with age on the normal side.In the 25–53-month group,testicular atrophy index and testicular volumes on either side were not correlated with age.A palpable unilateral cryptorchid testis is smaller than the contralateral testis.The testicular atrophy index increases with age between 6 months and 24 months,but not between 25 months and 53 months.Testicular volume increased with age on the normal side between 6 months and 24 months,but not on the cryptorchid side.Trends in testicular atrophy index with age contribute to the decision of operation time.
文摘This study aims to explore the factors influencing the success rate of the microdissection testicular sperm extraction(Micro-TESE)in patients with nonobstructive azoospermia(NOA)and cryptorchidism.Clinical data of 162 patients with cryptorchidism who underwent Micro-TESE due to infertility from December 2015 to May 2020 in the First Affiliated Hospital of Nanjing Medical University were analyzed retrospectively.In the univariate analysis,significant differences in the age of patient at the time of orchidopexy(median[interquartile range,IQR]:7.0[4.0–11.0]years vs 11.5[9.0–14.5]years,P<0.001),interval between orchidopexy and Micro-TESE(mean±standard deviation:17.5±5.0 years vs 14.4±4.4 years,P<0.001),severity of cryptorchidism(unilateral[62.8%]vs bilateral[31.6%],P<0.001;location of cryptorchidism,intra-abdominal[27.3%]vs inguinal[44.8%]vs suprascrotal[66.7%],P<0.001),volume of the dominant testis(median[IQR]:17.00[15.00–19.00]ml vs 14.50[11.75–16.25]ml,P<0.001),and levels of follicle-stimulating hormone(FSH;P=0.004)and testosterone(P=0.006)were observed between the successful and failed sperm extraction groups.After conducting the multivariate analysis,four of these factors,including unilateral/bilateral cryptorchidism(P<0.001),location of cryptorchidism(P=0.032),age of orchidopexy(P<0.001),and dominant testicular volume,were adopted in the clinical prediction model to evaluate preoperatively the success rate of Micro-TESE for patients with NOA and cryptorchidism.The likelihood of successful sperm retrieval by Micro-TESE in men with NOA and cryptorchidism increased in patients with mild forms of cryptorchidism.
文摘Cryptorchidism is associated with infertility in adulthood.Early orchiopexy is suggested to reduce the risk.Information is lacking on the potential link between infant germ cell maturation and the risk of future infertility.The objective of the study was to evaluate age-related germ cell development in cryptorchidism.Immunostaining for markers of germ cell development(octamerbinding transcription factor 3/4[0CT3/4],placental alkaline phosphatase[PLAP],KIT proto-oncogene[C-KIT],podoplanin[D2-40],Lin-28 homolog A[LIN28],and G antigen 7[GAGE-7])was performed in testicular biopsies from 40 cryptorchid boys aged 4-35 mon ths.Germ cell nu mbers and distributi ons were evaluated in cross sectio ns of semi niferous tubules,with and without immuno staini ng.OCT3/4,D2-40,and LIN 28 were gen erally expressed in the early stages of germ cell development,as show n by positive expression in germ cells in the central region of seminiferous tubules・In contrast,PLAP and GAGE-7 were expressed in both central and peripheral parts of the tubules in the early stages of development and expressed mainly in a peripheral position with advancing age.Germ cell maturation was delayed in this study population as compared with that observed in our previous study on germ cell markers in a healthy population.The number of GAGE-7-positive germ cells per tubular cross section obtained by immunostaining was significantly higher than that obtained by standard hematoxylin and eosin staining.Double immunostaining revealed heterogeneity in germ cell development in cryptorchid testes.These results shed light on the pathophysiology of germ cell development in boys with cryptorchidism.
