Diagnosis: Retractile Testis
The correct answer is D. Retractile testis, as the key diagnostic feature is that the testis can be easily manipulated into the scrotum, which distinguishes it from true undescended testis and is pathognomonic for a retractile testis. 1
Diagnostic Reasoning
Why This is Retractile Testis
The defining characteristic is that the testis "easily moved to scrotum" - this ability to manipulate the testis into the scrotum and have it remain there (at least temporarily) is the hallmark feature that distinguishes retractile testis from cryptorchidism 1
The testis being palpable in the inguinal canal is consistent with retractile testis, as this represents a hyperactive cremasteric reflex pulling the testis upward from its normal scrotal position 1
The smaller size is commonly seen with retractile testes and does not change the diagnosis when the testis is easily mobile into the scrotum 1
Why NOT the Other Options
B. Undescended testis (cryptorchidism):
- True undescended testes cannot be easily manipulated into the scrotum or do not remain there when placed 1
- In cryptorchidism, the testis is arrested along the path of descent and requires surgical intervention 1
- The fact that this testis "easily moved to scrotum" definitively rules out true cryptorchidism 1
A. Ectopic testis:
- An ectopic testis is located outside the normal path of descent (such as in the superficial inguinal pouch, perineum, or femoral region) 2
- This testis is in the inguinal canal, which is along the normal path of descent, not an ectopic location 2
C. Testicular torsion:
- Torsion presents as an acute surgical emergency with pain, swelling, and abnormal testicular lie 3
- This is a well-baby clinic visit with no mention of acute symptoms, and the testis is easily mobile - completely inconsistent with torsion 3
Management Approach
Annual monitoring is required because retractile testes carry a 32% risk of becoming truly undescended (ascending testis) during childhood 1, 4
Assess testicular position at least annually at well-child visits to monitor for secondary ascent 1
Do not order imaging studies (ultrasound or other modalities), as they rarely assist in decision-making 1
Critical Pitfalls to Avoid
The presence of a taut or inelastic spermatic cord increases the risk - 56% of retractile testes with this finding become undescended 4
Age matters for prognosis: Boys younger than 7 years have only a 21% chance of spontaneous descent compared to 58% in boys 7 years or older 4
Do not assume retractile testis is benign - 22-30% will require surgery eventually due to ascent or size decrease 5, 4
If the testis becomes difficult to manipulate into the scrotum or develops a taut cord on follow-up, refer to pediatric urology for possible orchiopexy 1, 4