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Retractile testes: follow up study

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The prevalence of retractile testes in school age boys has been estimated at between 4 and 13 per 1000 boys. Such testes have completed the descent process and can be brought down into the scrotum by manipulation but, when released, retract into the inguinal canal by cremasteric contraction. Although retractile testes are commonly regarded as normal there is still debate about their management. It is not known, for instance, how long each testis spends in the inguinal canal and whether the increase in surrounding temperature could be harmful. The experience of one paediatric surgeon has been reported (

).

The series included 150 consecutive boys referred between April 1982 and April 1999 with a primary care diagnosis of retractile testis or cryptorchidism. The average age at referral was 5.2 years and average follow up 3.8 years. There were 205 retractile testes; 58 on the right, 37 on the left, and 55 bilateral cases. Six boys had a contralateral undescended testis and 32 had an inguinal hernia. Orchidopexy was performed if the testis became fixed in a high position or if it failed to grow satisfactorily: it was performed in 37 boys, in 34 because the testis could no longer be brought into the scrotum and in three because of failure of testicular growth. Greater difficulty in manipulating the testis into the scrotum was a predictor of eventual orchidopexy. Orchidopexy was performed in 69% of boys with an associated hernia and 9% without. One patient who had cleft palate and duplication of the ureter on the same side as the retractile testis had normal descent of the testis but at the age of 16 developed testicular cancer in the previously retractile testis.

In this series of boys referred to a surgeon 37 of 150 boys came to orchidopexy. The authors of the paper conclude that all boys with retractile testes should be followed up (although 93 of the 205 testes were normally placed in the scrotum and only three of those came to orchidopexy). They suggest, oddly, that the follow up might be done on the boys’ birthdays. “Happy surgical appointment day, young man.”

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