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of veins known as pampiniform plexus cool the blood traveling to the testicles, allowing for them to remain at a temperature cooler than the core body heat. In varicoceles, these veins become enlarged, which disrupts the cooling process leading to less properly functioning sperm being produced. They can also lead to less testosterone being produced. Treatments are typically not used due to the harmless nature of varicoceles. However, treatments are available for individuals experiencing pain/discomfort, fertility problems, "symptoms of low testosterone levels", and unusual results from semen analysis. Treatments include medication to address pain, surgery (microscopic and laparoscopic varicocelectomy), and embolization. The goal of surgery and embolization is to hinder blood flow to the enlarged veins.
554:. Each of these conditions presents distinct challenges and may require specialized medical attention and surgical intervention. From atypical urethral placements and curvatures of the penis to ambiguous sexual characteristics and fluid accumulations, these conditions can impact a child's overall health and well-being. Early detection and timely management are crucial to achieving optimal outcomes and ensuring a healthy future for affected children. To address these complexities, multidisciplinary teams comprising pediatric urologists, surgical specialists, endocrinologists, geneticists, and neonatal care physicians collaborate to develop personalized treatment plans and deliver comprehensive care. This section explores these genital abnormalities and briefly introduces each of them.
505:. Penile cancer is due to trapped fluids under the foreskin of the penis. Uncircumcised individuals have a higher risk of penile cancer. Symptoms that may indicate penile cancer during male examination include lumps on the penis, swelling, and skin around the penis becoming thicker. Penile cancer and its grade is diagnosed by a biopsy to confirm. Testicular cancer is when malignant cells grow in the tissues of the testicles. Males are at higher risk of testicular cancer between the age of 15-35 years old. Testicular cancer signs include swelling and fluid build up in the scrotum. Other signs can be pain, and any new lumps in the testicles. Testicular cancer is confirmed by CT scans or an X-ray.
480:
experienced due to chronic epididymitis is usually more dull compared to acute epididymitis and can be intermittent. Typically, this condition is caused by a bacterial infection including a urinary tract infection or a sexually transmitted disease (such as chlamydia and gonorrhea). It can also be caused by: enlargement or infection of the prostate gland; blockage in the urethra (tube that carries urine out of the body); tuberculosis; amiodarone. Diagnosis may involve testing urine samples or an ultrasound. Treatment can include antibiotics, medications to address pain and swelling, or surgical removal of the epididymis.
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also check for it with a self-exam and should notify a health care provider if it greatly increases in size or firmness. If the size or pain become bothersome, there are treatment option available. Treatments include: medications to reduce pain and/or swelling; aspiration and sclerotherapy (minimally invasive therapies that are rarely recommended or used);
594:. Early diagnosis and timely management of epispadias are crucial to achieve optimal results and minimize potential complications. A multidisciplinary approach involving pediatric urologists and surgical specialists is essential to provide personalized treatment plans and comprehensive care for children born with this condition.
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which is present in 1 out of 250 children at birth. This condition is characterized by an atypical placement of the urethral opening, which is situated not at the usual location on the tip of the penis but rather positioned further down on the ventral surface, between the junction of the penile shaft
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A testicular self-examination can be done in front of a mirror to look at the entire surface. To properly examine the scrotum needs to be warm and relaxed. Each individual testicle needs to be inspected by rolling the testicle between the thumb and fingers over the entire surface of the testicle. It
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An epididymal cyst mostly occurs at the head of the epididymis, and it is rarely seen at the body and tail of the epididymis. An epididymal cyst is round or oval, with a smooth and transparent surface, capillary vessels on the surface of the cyst are visible, and boundaries between the cyst and its
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disorders. Throughout development, both male and female external genitalia originate from shared fundamental structures. As a consequence, children with XY genes may exhibit female genitalia, while those with XX genes may display male genitalia, leading to ambiguity in their sexual characteristics.
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are the swelling of the veins inside the scrotum typically on the left side. These masses may appear or feel similar to a "bag of worms". Usually varicoceles do not cause harm or pain, however, they can sometimes result in pain, infertility, or issues related to testicular growth. Normally, a group
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in the penis. Early detection and timely treatment of chordee contribute to more favorable outcomes, and regular follow-up with healthcare professionals ensures proper healing and successful resolution of the condition. The collaborative effort between pediatric urologists and surgical specialists
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Other abnormalities can be detected during male genital examination including
Peyronie's disease. Peyronie's disease is caused by an injury or an autoimmune disease that results in plaque build up under the skin of the penis. A lot of build up of this plaque will cause a curvature to the penis and
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is sperm accumulation in the epididymis. Spermatoceles are benign cysts, that are generally pain free. Some individuals may experience symptoms associated with the spermatoceles such as dull pain or heaviness in the scrotum. While this can be detected during the annual physical exam, a person can
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As part of pediatric medical evaluations, a comprehensive examination of the male genitalia plays a crucial role in identifying and addressing a range of genital abnormalities that can affect young boys. This examination seeks to determine the presence of any dysmorphic features and assess the
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is the inflammation (swelling) of the tube connecting testicle and vas deferens. When the testis becomes swollen, in addition to the epididymis, this is called epididymo-orchitis. Epididymitis can be acute (lasting less than six weeks) or chronic (lasting equal to or more than six weeks). Pain
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The external genital examination begins with the undressed examinee standing in front of the seated professional. The examiner visually scans the distribution of pubic hair and appearance of the external genital. Examiner notes presence of large masses, undescended testicles or bulges in groin
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is normal for one testicle to be to be larger than the other. During the examination an individual is searching for the appearance of any swelling, tenderness, bumps or blisters. It is important to reach out to a doctor if any abnormalities or new lumps are found.
775:, infection, etc. Fortunately, treating hydroceles is a straightforward process that involves closing the opening with an outpatient procedure. This effective intervention leads to a minimal recurrence rate, ensuring successful outcomes for the majority of cases.
590:, which serves as the passage for urine from the bladder out of the body, does not fully develop into a complete tube, leading to challenges in the process of urination. Additionally, 90% of children with epispadias often exhibit a co-occurring condition called
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Examine for masses in the scrotum by using a light source in a dark room to shine through region. If there is a solid tumor present, light will not be able to shine through. If there is a hydrocele, light that shines through will present itself as a red
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and might present with other associated developmental anomalies. Consequently, a thorough evaluation is essential to identify and address any potential health concerns or distinctive physical characteristics that may be present in affected infants.
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and genital area with adequate lighting is required. The ideal position is with the professional sitting in front of the examinee. The examination may take place with the individual sitting or laying face upward, but to investigate possible
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Esposito, Ciro; Valla, Jean
Stephanie; Najmaldin, Azad; Shier, Felix; Mattioli, Girolamo; Savanelli, Antonio; Castagnetti, Marco; McKinley, Gordon; Stayaert, Henry; Settimi, Alessandro; Jasonni, Vincenzo; Guys, Jean Michael (March 2004).
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For individuals with an uncircumcised penis, the foreskin is pulled back to expose the glans. Examiner palpates the shaft of penis and inspect for unusual firmness. In addition, examiner should note any ulcers or plaques present during
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In the majority of cases, testicles descend into the scrotum within the first year of a boy's life. However, if this descent does not occur during the initial year, surgical correction is recommended to prevent potential damage to the
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general health of the baby. Pediatric genital abnormalities encompass a diverse array of conditions that can arise during early development, affecting the sexual and reproductive organs of children. Among the most common anomalies are
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into the scrotum. Diagnosing undescended testicles involves a physical examination. If the testis cannot be felt, it is categorized as "non-palpable." Generally, there are three underlying reasons for nonpalpable testicles:
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Examiner slightly pulls opening of urethra using their thumb to expose the mucosa for inspection of lesions. If discharge is present in the urethral opening, cultures are collected to further assess for sexually transmitted
521:, urethral discharge, discomfort, sexually transmitted disease, urinary tract infection, and many others. The assessment may include social history, family history (ex: congenital anomalies), sexual behaviors and habits.
791:, and urinary issues. Clinicians use the male genital examination as an opportunity to promote sexual/reproductive health (SRH) among young males and provide education on male anatomy, function, and SRH-related matters.
460:(a surgical approach). Surgical/ invasive treatments may lead to fertility problems. Post treatment procedure may include wearing a pressure dressing, addressing swelling with ice packs, and taking medication for pain.
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is a mass that forms in the epididymis. These cysts differ from spermatoceles as they contain clear fluid, rather than seminal fluid. In addition, spermatoceles are more likely to be found on the head of the
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is most common in males between the age 20–34 years old, and can appear as soon as the age of 15 years old. It is important to start STE at a young age, to detect any possible signs for testicular cancer.
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Palpate scrotum to examine the appearance, size and position of the testicles. The normal shape of testicle is oval and smooth but tender to the touch. Examiner will note if testicle can be separated from
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is swelling from fluid collection in the sac surrounding the testicles. It can typically be found in male infants, but can also develop in boys during puberty as well as adults.
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represent one of the most frequently encountered conditions in newborns. For example, a study shows that undescended testicles affects approximately 4.8 percent of all
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can also be assessed as part of the male genital examination. During a genital examination, the doctor can detect any of the following: structural abnormalities (ex.
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refers to a curvature of the penis, a condition that can be present from birth. It is important to note that some children may have chordee without any accompanying
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is performed to determine the underlying cause. Laparoscopy alone is often effective in moving intra-abdominal testes into the scrotum. The correction of
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299:(ACHA) guidelines for Best Practices for Sensitive Exams, it is required to explain all expectations of the examination to the examinee prior to start.
748:. Detecting an inguinal hernia is typically characterized by a noticeable bulge in the groin or scrotum, which may vary in size. Hernias can emerge as
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251:) where a physical examination of the male genitals is not sufficient to diagnose an individual, then an internal genital examination using
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Thong M, Lim C, Fatimah H (January 1998). "Undescended testes: incidence in 1,002 consecutive male infants and outcome at 1 year of age".
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Nahata L, DaJusta D, Gupta
Basuray R (November 2015). "The Male Genital Examination: Overcoming Barriers to Prevent Missed Diagnoses".
448:. Ultrasounds for a mass growth may be ordered by a doctor for differentiation between spermatocele, varicocele, and epididymal cysts.
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An external examination may possibly detect structural abnormalities but may require exploratory surgery to determine diagnosis.
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plays a crucial role in providing tailored treatment plans and delivering comprehensive care for children dealing with chordee.
82:
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Parmar M, Masterson JM, Masterson TA (May 2020). "The role of imaging in the diagnosis and management of
Peyronie's disease".
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Examination of the external genitalia include an inspection and palpation of the penis, scrotum, and urethral meatus.
721:(undescended testicles) is associated with improved fertility potential, approaching that of the general population.
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or a more harmful disease. Testicular self-examinations only take a few minutes and should be done every four weeks.
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613:. Fortunately, this condition can often be effectively corrected through outpatient procedures involving surgical
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and the scrotum. Alongside this anatomical variation, affected children often exhibit a condition called
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Benign (not cancerous) mass may be present in scrotum and detected through palpation. These may include
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167:, and is normally a component of an annual physical examination. The examination includes checking the
1513:
Hornor G (May 2007). "Genitourinary assessment: an integral part of a complete physical examination".
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937:"The male genital examination: a position paper of the Society for Adolescent Health and Medicine"
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Rowe MI, Marchildon MB (October 1981). "Inguinal hernia and hydrocele in infants and children".
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Testicular self-examination (TSE) is performed to detect changes and symptoms that can indicate
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During the assessment of the genitourinary system, the doctor can detect any of the following:
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709:, as it functions optimally and grows best in the scrotal position. When the testis cannot be
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Yin Z, Ming X (2019). "General
Techniques of Scrotoscopic Surgery: 4.4.3.2 Epididymal Cyst".
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Parisi MA, Ramsdell LA, Burns MW, Carr MC, Grady RE, Gunther DF, et al. (June 2007).
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Male genital exam screening can detect early signs, or indication of cancers that include
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This examination serves various purposes, including the detection of conditions such as
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can cause pain during erection. It is more common in males over the age 40 years old.
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and note the connection to the testicle. In some instances, examiner will perform the
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1088:. Department of Health & Human Services, State Government of Victoria, Australia
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The second-most frequently encountered genital abnormality in children is known as
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1679:"A Gender Assessment Team: experience with 250 patients over a period of 25 years"
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and penis. The exam can also be conducted to verify a person's age and biological
16:"Genital examination" redirects here. For examination of the female genitals, see
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1678:
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Wampler SM, Llanes M (September 2010). "Common scrotal and testicular problems".
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During a male genital examination, a doctor will carefully inspect and check the
1856:"Incidence and management of hydrocele following varicocele surgery in children"
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Pais Jr VM, Wason SE, Seftel AD, Raz S (2023-05-30). Talavera F, Kim ED (eds.).
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571:, wherein the penis presents a curvature pointing downward towards the scrotum.
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During the comprehensive physical examination, it is crucial to assess for any
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Note: during a self-examination a person may detect a ropy tube which is the
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Palpate the inguinal canals to assess for hernias or abnormal tenderness.
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National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
752:(an emergency situation) or reducible hernia (a less urgent condition).
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if you can. Unsourced or poorly sourced material may be challenged and
1159:"Spermatocele: Practice Essentials, History of the Procedure, Problem"
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it is necessary that the person is standing in front of the examiner.
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744:, to close properly, resulting in an opening between the abdomen and
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681:, the back part of the abdomen, and subsequently descend through the
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Clinical
Methods: The History, Physical, and Laboratory Examinations
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and evaluate the overall health of the baby. Infants with XY DSD (
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Palpate abdominal region to determine if testicle is undescended.
1593:"Abnormalities of penile curvature: chordee and penile torsion"
247:, hair-related issues, and many others. In some instances (ex:
179:. A comprehensive assessment of the male genitals assesses the
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can manifest as a result of various factors, such as abnormal
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25:
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male newborns. During normal development, testes form in the
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condition that is evident from birth. In this condition, the
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Examination is repeated with the examinee in supine position.
1490:"Testicular Cancer: Symptoms, Signs, Causes & Treatment"
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Diamond DA, Ransley PG (December 1995). "Male epispadias".
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to assess the mass on the veins within the spermatic cord.
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1107:"Is It Normal for One Testicle to Be Bigger? (for Teens)"
57:
657:) may exhibit a higher likelihood of being small for
1466:"Penile Cancer: Symptoms, Diagnosis & Treatment"
1180:"Spermatoceles: Symptoms, Diagnosis & Treatment"
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in adults, these hernias involve the failure of the
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1267:"Varicoceles: Symptoms, Diagnosis & Treatment"
732:are a common occurrence in young children. Unlike
700:The testis does not exist on that side altogether.
1902:"Step-by-step guide to male genital examination"
1359:U.S. Centers for Disease Control and Prevention
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763:refers to the accumulation of fluid along the
271:of the scrotum and penis. The exposure of the
56:Please review the contents of the article and
1804:Yeap E, Pacilli M, Nataraja RM (2020-08-20).
1548:Baskin L (May 2017). "What Is Hypospadias?".
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694:but cannot be palpated for specific reasons.
1773:. Biliary Tract Disease Pediatric Surgery.
935:Marcell AV, Bell DL, Joffe A (April 2012).
850:. In Walker HK, Hall WD, Hurst JW (eds.).
697:The testis is situated inside the abdomen.
163:in males to detect ailments and to assess
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1694:
1618:
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1355:"Epididymitis - STI Treatment Guidelines"
952:
1442:"Penile Curvature (Peyronie's Disease)"
846:White Jr JM JR, O'Brien III DP (1990).
813:
771:. The accumulation can be indicator of
767:that covers the front and sides of the
259:will be needed for further evaluation.
1810:Australian Journal of General Practice
854:(3rd ed.). Boston: Butterworths.
132:
1771:The Surgical Clinics of North America
1026:Junnila J, Lassen P (February 1998).
402:sexually transmitted infections (STI)
7:
315:Return foreskin to normal position.
297:American College Health Association
1416:10.1016/B978-0-12-815008-5.00004-2
1213:. National Health Service Scotland
351:Areas for inspection and palpation
14:
1872:10.1097/01.ju.0000112928.91319.fe
1591:Montag S, Palmer LS (July 2011).
1515:Journal of Pediatric Health Care
1207:"Testicular lumps and swellings"
954:10.1016/j.jadohealth.2012.01.002
941:The Journal of Adolescent Health
122:
30:
1728:Pediatric Surgery International
1058:"How to Do a Genital Self-Exam"
525:Pediatric genital abnormalities
1806:"Inguinal hernias in children"
1429:surrounding tissues are clear.
359:Human male reproductive system
205:urethral opening abnormalities
58:add the appropriate references
1:
1783:10.1016/S0039-6109(16)42537-5
1656:10.1016/S0022-5347(01)66719-3
1082:"Testicular self examination"
1696:10.1097/GIM.0b013e3180653c47
990:10.1097/MOU.0000000000000754
803:- female genital examination
740:, the sac that encloses the
655:Disorders of Sex Development
1527:10.1016/j.pedhc.2006.05.012
509:Genitourinary abnormalities
396:Testicular self-examination
43:reliable medical references
1948:
1236:Boston Children's Hospital
978:Current Opinion in Urology
72:"Male genital examination"
15:
1597:TheScientificWorldJournal
1333:10.1016/j.pop.2010.04.009
1032:American Family Physician
848:"External Male Genitalia"
49:or relies too heavily on
1823:10.31128/AJGP-08-19-5037
1562:10.1177/0009922816684613
1323:. Primary Care Urology.
903:10.1177/0009922815577962
424:Structural abnormalities
153:Male genital examination
136:Male genital examination
1932:Male genital procedures
1470:Urology Care Foundation
1387:Urology Care Foundation
1383:"What is Epididymitis?"
1271:Urology Care Foundation
1184:Urology Care Foundation
542:, ambiguous genitalia,
517:, foul smelling urine,
1860:The Journal of Urology
1644:The Journal of Urology
1300:Johns Hopkins Medicine
360:
207:, problems related to
185:Sexual Maturity Rating
1740:10.1007/s003830050239
690:The testis is in the
671:Undescended testicles
666:Undescended testicles
617:and the placement of
544:undescended testicles
358:
209:not being circumcised
1683:Genetics in Medicine
1610:10.1100/tsw.2011.136
1408:Scrotoscopic Surgery
789:Klinefelter syndrome
288:External Examination
197:genitourinary system
187:and the size of the
157:physical examination
1550:Clinical Pediatrics
1028:"Testicular masses"
891:Clinical Pediatrics
750:strangulated hernia
651:dysmorphic features
634:Ambiguous genitalia
629:Ambiguous genitalia
23:Medical examination
1410:. pp. 23–53.
1111:Nemours KidsHealth
801:Pelvic examination
644:complications, or
361:
249:Peyronie's disease
165:sexual development
18:Pelvic examination
1131:"Testicular exam"
897:(13): 1237–1239.
861:978-0-409-90077-4
785:testicular cancer
592:bladder exstrophy
503:testicular cancer
458:spermatocelectomy
406:Testicular cancer
335:Valsalva maneuver
295:According to the
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730:Inguinal hernias
725:Inguinal hernias
548:inguinal hernias
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430:epididymal cysts
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845:
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815:
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797:
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727:
679:retroperitoneum
668:
659:gestational age
631:
600:
577:
560:
527:
511:
426:
398:
353:
290:
265:
177:urethral meatus
127:
123:
118:
112:
109:
66:
55:
51:primary sources
35:
31:
24:
21:
12:
11:
5:
1945:
1943:
1935:
1934:
1924:
1923:
1918:
1917:
1893:
1845:
1816:(1–2): 38–43.
1796:
1761:
1718:
1689:(6): 348–357.
1669:
1634:
1583:
1556:(5): 409–418.
1540:
1521:(3): 162–170.
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1038:(4): 685–692.
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984:(3): 283–289.
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947:(4): 424–425.
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809:
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779:Other purposes
777:
757:
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726:
723:
719:cryptorchidism
702:
701:
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695:
692:inguinal canal
683:inguinal canal
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1603:: 1470–1478.
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499:penile cancer
495:
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145:Male genitals
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113:February 2022
105:
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77:
74: –
73:
69:
68:Find sources:
63:
59:
53:
52:
48:
44:
39:This article
37:
28:
27:
19:
1909:. Retrieved
1906:Healthy Male
1905:
1896:
1863:
1859:
1848:
1813:
1809:
1799:
1774:
1770:
1764:
1734:(1): 37–41.
1731:
1727:
1721:
1686:
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1672:
1647:
1643:
1637:
1600:
1596:
1586:
1553:
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1543:
1518:
1514:
1508:
1497:. Retrieved
1493:
1484:
1473:. Retrieved
1469:
1460:
1449:. Retrieved
1445:
1436:
1427:
1407:
1401:
1390:. Retrieved
1386:
1363:. Retrieved
1361:. 2021-07-14
1358:
1349:
1324:
1321:Primary Care
1320:
1314:
1303:. Retrieved
1299:
1296:"Varicocele"
1274:. Retrieved
1270:
1239:. Retrieved
1235:
1226:
1215:. Retrieved
1210:
1187:. Retrieved
1183:
1138:. Retrieved
1134:
1125:
1114:. Retrieved
1110:
1101:
1090:. Retrieved
1085:
1076:
1065:. Retrieved
1061:
1052:
1035:
1031:
981:
977:
971:
944:
940:
894:
890:
884:
873:. Retrieved
851:
782:
759:
728:
703:
669:
632:
601:
578:
561:
528:
512:
496:
492:
477:Epididymitis
453:Spermatocele
446:epididymitis
434:spermatocele
427:
415:
411:
399:
346:
329:Palpate the
294:
291:
266:
152:
151:
141:Test of
110:
100:
93:
86:
79:
67:
47:verification
40:
1232:"Hydrocele"
1135:Mayo Clinic
715:laparoscopy
638:chromosomes
607:hypospadias
564:hypospadias
558:Hypospadias
532:hypospadias
489:epididymis.
470:Varicoceles
319:epididymis.
312:infections.
257:ultrasounds
229:excoriation
41:needs more
1911:2023-07-25
1499:2023-07-31
1475:2023-07-31
1451:2023-07-31
1392:2023-07-30
1365:2023-07-30
1305:2023-07-30
1276:2023-07-31
1241:2023-07-30
1217:2023-07-31
1211:NHS inform
1189:2023-07-30
1140:2023-07-26
1116:2023-07-31
1092:2023-07-27
1067:2023-07-26
875:2023-07-26
808:References
742:intestines
738:peritoneum
611:epispadias
584:congenital
580:Epispadias
575:Epispadias
552:hydroceles
536:epispadias
442:varicocele
418:epididymis
390:epididymis
308:palpation.
278:varicocele
201:varicocele
181:pubic hair
83:newspapers
1880:0022-5347
1840:211013760
1006:214630106
761:Hydrocele
756:Hydrocele
675:Malaysian
646:enzymatic
619:placating
615:resection
519:hematuria
464:Hydrocele
438:hydrocele
386:Testicles
269:palpation
263:Procedure
189:testicles
183:based on
1926:Category
1888:14767329
1832:32008266
1713:21141446
1705:17575501
1629:21805016
1578:79200282
1570:28081624
1535:17478305
1424:81292862
1341:20705202
998:32205808
963:22443851
911:25813382
870:21250142
795:See also
769:testicle
765:membrane
711:palpated
241:swelling
213:phimosis
1791:7313928
1756:2480813
1748:9391202
1664:7500480
1620:5720069
1044:9490992
919:2424547
746:scrotum
734:hernias
642:gonadal
622:sutures
603:Chordee
598:Chordee
588:urethra
569:chordee
540:chordee
515:dysuria
381:Scrotum
304:region.
253:imaging
237:lesions
225:redness
173:scrotum
161:genital
159:of the
97:scholar
62:removed
1886:
1878:
1838:
1830:
1789:
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1004:
996:
961:
917:
909:
868:
858:
707:testis
550:, and
367:region
323:color.
282:hernia
245:cancer
221:tumors
195:. The
175:, and
99:
92:
85:
78:
70:
1836:S2CID
1752:S2CID
1709:S2CID
1574:S2CID
1420:S2CID
1002:S2CID
915:S2CID
773:tumor
582:is a
376:Glans
371:Penis
365:Pubic
273:groin
233:edema
217:lumps
211:(ex.
169:penis
155:is a
104:JSTOR
90:books
1884:PMID
1876:ISSN
1828:PMID
1787:PMID
1744:PMID
1701:PMID
1660:PMID
1625:PMID
1566:PMID
1531:PMID
1337:PMID
1040:PMID
994:PMID
959:PMID
907:PMID
866:PMID
856:ISBN
501:and
388:and
280:and
76:news
45:for
1868:doi
1864:171
1818:doi
1779:doi
1736:doi
1691:doi
1652:doi
1648:154
1615:PMC
1605:doi
1558:doi
1523:doi
1412:doi
1329:doi
986:doi
949:doi
899:doi
609:or
255:or
215:),
203:),
193:sex
1928::
1904:.
1882:.
1874:.
1862:.
1858:.
1834:.
1826:.
1814:49
1812:.
1808:.
1785:.
1775:61
1750:.
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1732:13
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1707:.
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1572:.
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1554:56
1552:.
1529:.
1519:21
1517:.
1492:.
1468:.
1444:.
1426:.
1418:.
1385:.
1374:^
1357:.
1335:.
1325:37
1298:.
1285:^
1269:.
1250:^
1234:.
1209:.
1198:^
1182:.
1167:^
1149:^
1133:.
1109:.
1084:.
1060:.
1036:57
1034:.
1030:.
1014:^
1000:.
992:.
982:30
980:.
957:.
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864:.
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115:)
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20:.
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