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Causes
By Mayo Clinic staffAn overactive muscle causes a testicle to become a retractile testicle. The cremaster muscle is a thin pouch-like muscle in which a testicle rests. When the cremaster muscle contracts, it pulls the testicle up toward the body.
The primary purpose of the muscle is to control the temperature of the testicle. In order for a testicle to develop and function properly, it needs to be slightly cooler than normal body temperature. When the environment is warm, the cremaster muscle is relaxed; when the environment is cold, the muscle contracts and draws the testicle toward the warmth of the body.
During childhood, the cremaster muscle may be particularly overactive. If this reflex is strong enough, it can result in a retractile testicle, pulling the testicle out of the scrotum and up into the groin.
Causes of an ascending testicle
Retractile testicles are more likely than normal testicles to become ascending testicles. This means a once-movable testicle can no longer be easily guided into position in the scrotum. Instead of being capable of moving up and down (retractile), the testicle is stuck in the "up position" (ascending).
The ascending testicle occurs because some part of the anatomy is pulling up on the testicle. Contributing factors may be:
- Short spermatic cord. Each testicle is attached to the end of the spermatic cord, which extends down from the groin and into the scrotum. The cord houses blood vessels, nerves and the tube that carries semen from the testicle to the penis. If growth of the spermatic cord doesn't keep pace with other body growth, the "shortened," or "tight," cord may pull the testicle up.
- A problem with the normal path of a descending testicle. Before a testicle descends during fetal development, a tiny bag-like extension of the abdominal lining creates a path for the testicle to follow into the scrotum. Normally the thin upper portion of this bag closes off, and any remnants of the upper portion disintegrate. Sometimes this structure fails to close off and detach from the abdomen, resulting in an upward pull on the testicle.
- Scar tissue from hernia surgery. A hernia is caused by a small gap in the abdominal lining through which a portion of the intestines can push itself into the groin. This condition is called an inguinal hernia. Scar tissue following surgery to repair the hernia may limit the growth or elasticity of the spermatic cord.
- Agarwal PK, et al. Retractile testis — Is it really a normal variant? Journal of Urology. 2006;175:1496.
- La Scala, et al. Retractile testes: an outcome analysis on 150 patients. Journal of Pediatric Surgery. 2004;39:1014.
- Cooper CS, et al. Urology. In: Doherty GM. Current Diagnosis and Treatment: Surgery. 13th ed. New York, N.Y.: McGraw-Hill Medical; 2010. http://www.accessmedicine.com/content.aspx?aID=5312459. Accessed March 10, 2010.
- Stec AA, et al. Incidence of testicular ascent in boys with retractile testes. Journal of Urology. 2007;178:1722.
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- Pettersson A, et al. Age at surgery for undescended testis and risk of testicular cancer. New England Journal of Medicine. 2007;356:1835.
- Charles JC. The fate of the retractile testicles. Journal of Urology. 2003;171:1237.
- Hack WW. Natural history and long-term testicular growth of acquired undescended testis after spontaneous descent or pubertal orchidopexy. BJU International. In Press. Accessed March 12, 2010.
- Sandlow JI, et al. Surgery of the scrotum and seminal vesicles. In: Wein AJ, et al. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/188759382-2/966699837/1445/37.html?printin. Accessed March 11, 2010.
- Hoecker JL (expert opinion). Mayo Clinic, Rochester, Minn. March 15, 2010.
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