Undescended Retractile Testis

A retractile testis is a normally descended testis that moves up into the groin because of an overactive cremasteric reflex, and it can be manipulated back into the scrotum without tension.

• It is commonest in boys aged 4 to 8 years, when the cremasteric reflex is active, and is generally benign.
• The testis is normal in size and position when relaxed (for example in a warm bath).
• Some retractile testes become ascending (acquired undescended) testes, typically in about 2 to 5 percent, and need follow-up.
• True undescended testis is fixed, cannot be brought to the scrotum, and needs surgery.

The testis is sometimes in the scrotum and sometimes in the groin.

• Painless, with the testis intermittently noted in the scrotum and intermittently in the inguinal region.
• On examination, the testis can be gently milked down into the scrotum and stays there, without tension or pain.
• Scrotum is well developed and the testis is of normal size.
• Return to the groin after release suggests an ascending (acquired undescended) testis.
• Differential diagnosis: true undescended testis, ascending testis, inguinal hernia, hydrocele, testicular torsion (when acute), anorchia and ectopic testis.
• Complications: ascent over time into acquired undescended testis, with risk to fertility and malignancy.

Diagnosis is by careful clinical examination.

• Examine warm, relaxed, in supine and standing (or squatting) positions, using soap or lubricant on warm hands.
• Milk the testis from the inguinal canal into the scrotum; a retractile testis reaches the scrotum without tension and stays there.
• Compare testicular size and consistency.
• Ultrasound is not needed routinely. It is reserved for non-palpable or equivocal findings.

Observation is the usual approach.

• Supportive: reassure parents. Annual examination until puberty to detect ascent. Teach the family to check.
• Pharmacological: none. Hormonal therapy is not effective.
• Procedures: surgery (orchidopexy) if the testis no longer reaches the scrotum without tension (ascending testis), preferably before age 1 to 2 years for congenital cases or when ascent is confirmed.
• Special groups: boys with previous inguinal hernia repair, hypospadias, or spina bifida are at risk for ascent and need review.
• Red flags: testis no longer reaching the scrotum, acute testicular pain or swelling, small or soft testis and groin mass.
• Follow-up: annual examination until puberty. Refer to paediatric surgery or urology if the testis becomes fixed in the groin.