From the Guidelines
Surgical correction of a retractile testicle is generally not recommended unless it fails to descend by puberty, typically around age 10-13 years. Retractile testes are different from undescended (cryptorchid) testes, as they can move freely between the scrotum and inguinal canal but can be manually guided into the proper scrotal position. Most retractile testes will descend permanently on their own without intervention, typically by puberty. The provided evidence primarily focuses on the management of cryptorchidism, which is distinct from retractile testes, but it emphasizes the importance of monitoring and potential intervention to prevent long-term issues such as fertility problems and testicular cancer 1. Key points to consider include:
- Retractile testes can be distinguished from undescended testes by their ability to be manually guided into the scrotum.
- The majority of retractile testes will spontaneously descend by puberty.
- Surgical intervention for retractile testes that have not descended by puberty may be considered to mitigate potential risks of infertility and testicular cancer.
- Regular monitoring by a pediatrician or pediatric urologist is crucial for determining the appropriate timing and necessity of surgical intervention.
- The evidence from studies on cryptorchidism highlights the importance of early intervention for undescended testes, typically before 18 months of age, to preserve fertility potential and reduce the risk of testicular cancer 1. However, the management of retractile testes, as distinct from cryptorchidism, prioritizes a wait-and-see approach until puberty, unless complications or failure of spontaneous descent occur.
From the Research
Surgical Correction of Retractile Testicle
- The decision to surgically correct a retractile testicle depends on various factors, including the age of the patient and the presence of any associated conditions 2.
- According to a study published in 2004, the majority of patients (77.3%) with retractile testes have a spontaneously favorable evolution by 14 years of age and do not require surgical treatment 2.
- However, another study published in 2016 recommends prompt orchiopexy for palpable testes, as data do not support monitoring until adolescence to determine whether the testis will spontaneously descend into the scrotum 3.
- The American Academy of Pediatrics recommends that orchiopexy should be performed between 12 and 18 months of age to prevent the degenerative changes that are demonstrable by 2 years 4.
- A German guideline published in 2020 recommends that therapy for undescended testis should take place between 6 and 12 months of life, and that surgical intervention is the treatment of choice after the first year of life 5.
- In cases where the testicle is retractile, surgery may be indicated if the testicle ascends and becomes cryptorchid or if testicular size decreases during follow-up 2.
- The presence of an associated hernia increases the likelihood of requiring surgery, with 68.8% of cases requiring orchidopexy 2.
Age of Surgical Correction
- The optimal age for surgical correction of a retractile testicle is not well established, but most studies recommend orchiopexy between 12 and 18 months of age 3, 4.
- A study published in 1996 recommends that true undescended testes should be treated by orchiopexy before the patient reaches the age of 3 years to permit optimal tubular development and sperm function 6.
- Another study published in 2020 recommends that therapy for undescended testis should take place between 6 and 12 months of life 5.
Associated Conditions
- The presence of an associated hernia increases the likelihood of requiring surgery for a retractile testicle 2.
- Hypoplastic cryptorchid testes should be removed early, and high-positioned testes that have not been surgically placed into the scrotum before midadolescence generally should be removed 6.