Retractile testicle

Symptoms:

During fetal development, testicles form in the abdomen, and they gradually descend into the scrotum during the final months of development. If the testicle originally descended as it should but didn't remain in its place, it means that the boy has a retractile testicle.

Retractile testicle may cause some of these signs and symptoms:

• The testicle may be moved by hand into the scrotum and won't immediately "retreat" to the groin.
• It may spontaneously "appear" in the scrotum and remain there for a time.
• It may spontaneously "disappear" again for a time.

A retractile testicle is only noticed when it's no longer seen or felt in the scrotum because the movement of the testicle almost always occurs without pain or discomfort.
A boy may have one normal testicle and one retractile testicle, so the position of one testicle is usually independent of the position of the other one.
Undescended testicle (cryptorchidism) is different from retractile testicle. The undescended testicle is one that has never entered the scrotum. An undescended testicle wouldn’t move or would move only slightly causing some discomfort or pain in case the doctor tries to guide it.

Causes:

A testicle becomes a retractile testicle due to an overactive muscle. The thin pouch-like muscle in which a testicle rests is the cremaster. The cremaster muscle pulls the testicle up toward the body when it contracts.

To control the temperature of the testicle is the primary purpose of the muscle. The testicle needs to be slightly cooler than normal body temperature in order to develop and function properly. The cremaster muscle is relaxed when the environment is warm, and the muscle contracts and draws the testicle toward the warmth of the body when the environment is cold.

The cremaster muscle may be particularly overactive during childhood. It can result in a retractile testicle, pulling the testicle out of the scrotum and up into the groin, if this reflex is strong enough.

WHAT CAUSES AN ASCENDING TESTICLE?
In the case of an ascending testicle, a once-moveable testicle can no longer be easily guided into position in the scrotum, which happens in about one-third of retractile testicles cases. The testicle is stuck in the "up position" (ascending) instead of being capable of moving up and down (retractile).

A normal testicle residing in the scrotum, which is one that was never retractile, can also move permanently into the "up position", or become an ascending testicle.
When some part of the anatomy pulls up on the testicle, an ascending testicle occurs. Some of the factors that could contribute to this include:

• Short spermatic cord: The spermatic cord extends from the groin into the scrotum. Each testicle is attached to the end of the spermatic cord. Blood vessels, nerves and the tube that carries semen from the testicle to the penis are found in the cord. The "shortened" or "tight" cord may pull the testicle up if growth of the spermatic cord doesn't keep pace with other body growth.
   
• Problems with the normal path of a descending testicle: A tiny bag-like extension of the abdominal lining creates a path for the testicle to follow into the scrotum before it descends during fetal development. The thin upper portion of this bag closes off normally, and any remnants of the upper portion disintegrate. This structure may sometimes fail to close off and detach from the abdomen, resulting in an upward pull on the testicle. In other cases, the spermatic cord may pull upward on the testicle in case the top portion closes off, but a remnant of the structure remains and limits the growth or elasticity of the spermatic cord.
   
• Scar tissue from hernia surgery: Inguinal hernia is the condition in which a small gap in the abdominal lining through which a portion of the intestines can push itself into the groin results from an incomplete closure of the bag-like extension from the abdomen. The growth or elasticity of the spermatic cord may be limited due to scar tissue following surgery to repair the hernia.
   
• Other injuries: The growth or elasticity of the spermatic cord may also be limited by scar tissue from a testicular infection or a traumatic injury.

Complications:

A testicle needs to be in the scrotum in order for it to mature properly. Complications associated with undescended testicles are well documented. However, complications that result from ascending and retractile testicles are less known.

Some of the complications that a boy with a retractile testicle may be susceptible to include:

• Testicular cancer: Testicular cancer usually begins in the cells in the testicle that produce immature sperm. However, it's not known what causes these cells to develop into cancer. The risk of having testicular cancer is greater in men who have had an undescended testicle.
   
• Fertility problems: Men who have had an undescended testicle are more likely to have poor sperm quality, low fertility rates and low sperm counts.
   
• Testicular torsion: The twisting of the spermatic cord is a painful condition called testicular torsion, which cuts off blood to the testicle. This condition may result in the loss of the testicle if not treated promptly. The risk of testicular torsion is increased by an undescended testicle.
   
• Trauma: Due to its compression against the pubic bone, a testicle located in the groin may be susceptible to trauma or injury.

Treatments:

Before or during puberty, a retractile testicle is likely to descend on its own. The boy's doctor will monitor any changes in the testicle's position in annual evaluations to determine if the testicle stays in the scrotum, remains retractile or has become an ascending testicle.

Treatments will be recommended if the testicle has ascended, which means that it is no longer moveable by hand; or if it's still retractile by the age of 14. Having the testicle permanently descend and thereby lessen the risk of complications is the goal of the treatment. Treatments include:

• Hormone therapy: Descent of the testicle can sometimes be induced with hormone therapy using human chorionic gonadotropin (HCG), because this process is partially regulated by hormones. HCG is administered by injection, usually twice weekly for four weeks.
   
• Surgery: The most common treatment of this condition is a surgical procedure called orchiopexy. The surgeon guides the testicle to its proper position and stitches it into place through one incision in the groin and another in the scrotum. Usually, annual follow-up exams are recommended.

People should keep in mind that the increased risk of cancer remains even with successful treatment of an ascending or retractile testicle. Additionally, a testicle is more easily monitored if it is permanently in the scrotum rather than in the groin. And for that reason, abnormal cancerous growths would be treated sooner because they are detected earlier.

To ensure that the testicle doesn't ascend at a later time, adolescent boys and men who have had treatments to correct an ascending or retractile testicle should regularly monitor the position of their testicle.

Prognosis:

Not available

Expert's opinion: