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The Incidence of Secondary Ascent of Retractile Testes
George A. Turini, III, MD, Eugene Cone, BS, Michael Poch, MD, Anthony Caldamone, MD.
Alpert Medical School of Brown University, Providence, RI, USA.

BACKGROUND:The natural history of retractile testes is controversial. The incidence of secondary ascent in retrospective studies has previously been reported to be between 7 and 45%. The purpose of this study was to determine the incidence of secondary ascent of retractile testes and evaluate risk factors which may determine which testes that are more likely to descend or become ascended.
METHODS:Boys age 0-16 with a history and exam consistent with a retractile testis confirmed by a single pediatric urologist (AC) between 2006 and 2010 were enrolled in this study. A retractile testis was defined as a testis that was not spontaneously descended on exam but able to be brought into the scrotum where it stayed transiently upon fatigue of the cremasteric muscle, and appeared normal in size. A total of 143 patients were evaluated for retractile testes during our study period of whom 77 patients (mean age = 4.4 yrs) were evaluated more than once and entered into our IRB approved prospective database. The average number of follow up exams was 3.47 (range 2-13) spanning 3 months to 10 years after initial presentation. The patient's pertinent history including age, history of prematurity, other medical history and physical exam findings was recorded. Fischer's exact test and T-test were utilized for statistical analysis.
RESULTS: Of the 77 patients for whom data was available, 46 presented with bilateral retractile testes. Seventeen patients (22.0%) were premature (born before 38 weeks) of whom 6 were born prior to 30 weeks. Fifteen (19.5%) patients developed a secondarily undescended testicle which required surgical correction and, therefore was confirmed by an exam under anesthesia. Average time to ascent from initial presentation was 3.03 years (range .6 to 6.66). Low birth weight increased risk of ascent (p=0.084). Other variables such as age at presentation, prematurity, birth weight and prenatal US were not associated with increased risk of ascent.
CONCLUSIONS:While retractile testes remain a distinct entity from undescended testicles, which have a proven increased risk of malignancy and decreased fertility, a retractile testis' potential for pathologic disease is unknown. The clinical management of a retractile testis would be significantly influenced by the knowledge of the rates of secondary ascent and potential risk factors portending that outcome. Our experience demonstrates a rate of secondary testicular ascent of approximately 20%. We found a trend towards secondary ascent in boys with a history of low birth weight.


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