A careful physical examination is essential to determine whether a testis is cryptorchid or retractile (110). If the scrotum is empty, it is fundamental to decide whether the testis is palpable. Repeated physical examinations may be necessary if it is unclear whether a testis is present or to determine the location of a palpable testis. Incompletely descended testes are not usually fixed in position. A testis may at one examination be just palpable at the internal inguinal ring and on another occasion be impalpable, or the location may be high scrotal on one occasion and in the inguinal canal on another. Also, the location on physical examination may differ from that when the patient is under general anesthesia in preparation for surgery.
If a testis is not palpable, laparoscopy may determine not only its presence but also its location (111,112). As noted in the section on hormonal treatment, hormone stimulation (hCG, GnRH, or GnRH analog) may also be used to determine the presence of testicular tissue, because a rise in the serum testosterone level indicates the presence of functional Leydig cells. However, this test is only needed when neither testis is palpable.
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