Description, Causes and Risk Factors:
A retractile testicle is a testicle that may move back and forth between the scrotum and the groin. When the retractile testicle is residing in the groin, it may be easily guided by hand into its proper position in the scrotum - the bag of skin hanging behind the penis - during a physical examination.
An overactive muscle causes a testicle to become a retractile testicle. The cremaster muscle is a thin pouch-like muscle in which a testicle rests. When the cremaster muscle contracts, it pulls the testicle up toward the body.
The primary purpose of the muscle is to control the temperature of the testicle. In order for a testicle to develop and function properly, it needs to be slightly cooler than normal body temperature. When the environment is warm, the cremaster muscle is relaxed; when the environment is cold, the muscle contracts and draws the testicle toward the warmth of the body.
During childhood, the cremaster muscle may be particularly overactive. If this reflex is strong enough, it can result in a retractile testicle, pulling the testicle out of the scrotum and up into the groin.
Causes and Risk Factors:
A problem with the normal path of a descending testicle. Before a testicle descends during fetal development, a tiny bag-like extension of the abdominal lining creates a path for the testicle to follow into the scrotum. Normally the thin upper portion of this bag closes off, and any remnants of the upper portion disintegrate. Sometimes this structure fails to close off and detach from the abdomen, resulting in an upward pull on the testicle.
Scar tissue from hernia surgery. A hernia is caused by a small gap in the abdominal lining through which a portion of the intestines can push itself into the groin. This condition is called an inguinal hernia. Scar tissue following surgery to repair the hernia may limit the growth or elasticity of the spermatic cord.
Short spermatic cord. Each testicle is attached to the end of the spermatic cord, which extends down from the groin and into the scrotum. The cord houses blood vessels, nerves and the tube that carries semen from the testicle to the penis. If growth of the spermatic cord doesn't keep pace with other body growth, the "shortened," or "tight," cord may pull the testicle up.
For most boys, the problem of a retractile testicle goes away sometime before or during puberty because this is usually when the testicle permanently moves to its correct location in the scrotum.
Sometimes, the retractile testicle is no longer movable and instead stays up in the groin. When this happens, the testicle is no longer considered a retractile testicle. This condition is called an ascending testicle.
Researchers found that a retractile testis would more likely descend in a boy older than 7 years than in a boy younger than 7. In boys 7 years or older, the testis had a 19% chance of remaining retractile, compared with a 44% chance in boys younger than 7. If a boy had 1 retractile testis and 1 descended testis at the start of the study, then 69% of the retractile testes descended, and only 32% required an orchiopexy. On the other hand, those with 1 retractile testis and 1 undescended testis at the start of the study had a greater likelihood of the retractile testis requiring an orchiopexy for the undescended testis.
This study is important because it demonstrates that the retractile testis is not a normal variant; it has a significant risk of undergoing ascent and residing outside of the scrotum. These findings highlight the need for long-term follow-up in boys with retractile testes, given that 32% of these retractile testes become ascending testes. The risk is greater in boys younger than 7 years and in those with an inelastic spermatic cord.
It may spontaneously appear in the scrotum and remain there for a time.
It may spontaneously disappear again for a time.
The testicle may be moved by hand from the groin into the scrotum and won't immediately retreat to the groin.
If your son has a testicle not located in the scrotum, his doctor will determine its location in the groin. Once it's located, the doctor will attempt to guide it gently into its proper position in the scrotum.
Your son may be lying down, sitting or standing during this examination. If your son is a toddler, the doctor may have him sit with the soles of his feet touching and knees to the side. Older boys may be asked to squat. These positions often make it easier to find and manipulate the testicle. In addition, it's important that this exam is done in a warm location and that the doctor has warm hands, because cold can stimulate the cremaster reflex.
If the testicle is a retractile testicle, it will move relatively easily and painlessly. The retractile testicle won't immediately move up again. Your son's doctor can then stimulate the reflex of the cremaster muscle by gently rubbing the upper inside of the thigh. This stimulation will usually cause the retractile testicle to move up again
Retractile testicles do not require treatment. As boys reach early adolescence, the testicles enlarge and the cremasteric muscle reflex weakens, so the testicles usually descend back into the scrotum on their own. Retractile testicles appear to be otherwise normal and do not have the risks for infertility or testicular cancer that are associated with true undescended testicles.
NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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