Can testes get stuck in a retracted position at 15 months of age?

Can Testes Get Stuck Retracted at 15 Months of Age?

Yes, testes can become "stuck" in a retracted position at 15 months of age—this phenomenon is called acquired cryptorchidism or secondary testicular ascent, and it requires surgical referral because these testes will not spontaneously descend and face the same fertility and cancer risks as congenital undescended testes. 1

Understanding the Distinction

At 15 months, you need to differentiate between three conditions:

• Retractile testis: Can be easily manipulated into the scrotum and stays there without traction—this represents a hyperactive cremasteric reflex 2
• Acquired cryptorchidism (secondary ascent): A previously descended testis that has ascended and cannot be manipulated back into the scrotum—this is what "getting stuck" means 1
• Congenital undescended testis: Never descended in the first place 1

The Risk of Secondary Ascent

Retractile testes carry a 2-45% risk of becoming truly undescended (secondary ascent) during childhood, which is mechanistically related to hyperactive cremasteric reflex, foreshortened patent processus vaginalis, or entrapping adhesions 1. This wide range reflects real clinical variability, but the key point is that retractile testes are NOT benign and require monitoring 1.

Critical Management at 15 Months

If the testis cannot be manipulated into the scrotum and kept there without traction at 15 months, refer immediately to a pediatric urologist or pediatric surgeon for orchiopexy. 1 Here's why this age matters:

• Germ cell damage begins after 15-18 months: Some cryptorchid boys start lacking germ cells in the testes after this age, with progressive loss of fertility potential 1
• Optimal surgical window is closing: Orchiopexy should ideally be performed by 18 months to preserve fertility potential 1
• 25% of cryptorchid boys are already born with reduced germ cells, and the damage accelerates after 15-18 months 1

What to Do Now

Examine the child in a warm room with warm hands to minimize cremasteric reflex activation:

• If you can manipulate the testis into the scrotum and it stays there without holding it, this is retractile—schedule annual monitoring 1, 2
• If you cannot manipulate it into the scrotum, or it immediately retracts when you let go, this is acquired cryptorchidism—refer urgently for surgery 1, 3

Common Pitfalls to Avoid

• Do NOT order ultrasound or other imaging—these studies rarely assist in decision-making for palpable testes and delay appropriate surgical referral 1, 2
• Do NOT use hormonal therapy (hCG or GnRH)—success rates are only 6-38% in controlled studies, with high recurrence rates and potential harm to germ cells 1, 4
• Do NOT assume a retractile testis is benign—annual monitoring is mandatory through childhood because 2-45% will develop secondary ascent 1, 2
• Do NOT delay referral past 18 months—fertility preservation depends on timely surgery 1

Long-term Implications

Even with successful orchiopexy, this child will need:

• Lifelong surveillance for testicular cancer—the relative risk is 2.75-8 times higher, though prepubertal orchiopexy reduces this risk 2-6 fold compared to postpubertal surgery 1, 3
• Counseling about fertility implications—there may be inherent testicular dysfunction beyond just the mechanical issue of position 5, 3
• Annual clinical examination and self-examination training when age-appropriate 3