retractile testes

[Martha__0__0]

  I have been to a pediatric urologist about my 14 month old's retractile testes.  After a quick exam, he said the protocol was not to treat but to re-check every year until puberty, at which time he would need surgery if they were not permanently descended.  I still worry about infertility...if the testes are hardly ever descended, as my sons are, how can the heat inside the body cavity not be an issue?  Also, I read that some urologists differentiate between gliding and retractile testes, with a gliding testicle being one that glides right back up after being brought into the scrotum and a retractile being one that stays down for a few seconds.  The article said that gliding testes should be treated with surgery.  This was a Canadian document.  Are American physicians undertreating retractile testes?  Am I concerned over nothing?  Also, I have no proof, but I seem to recall that his testes were usually descended much more frequently, or even all the time, when he was younger than they are now.  

[HFHS M.D.-JJ]

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Dear Martha:
You have obviously done a great deal of research in this regard and maybe some of this information may seem redundant, but please bear with me.  
Undescended testicles are called “cryptorchid”.  The incidence of cryptorchidism is approximately 2-4 percent in all newborn boys.  The incidence is higher in boys who are born premature.  In such individuals, the testicle can be found anywhere in the inguinal canal, and possibly up in the abdomen (failing to have descended or partially descended).  The testicles in cryptorchid boys can not be brought down to the scrotum, or may brought down manually during examination under tension.  However, in normal boys with retractile testicles, the testicle can be brought down to the scrotum, but may retract again secondary to the cremasteric reflex.  The cremasteric reflex results in elevation of the testicle into the upper scrotal or intracanicular position by contraction of the cremasteric muscles which are stimulated through this reflex.  Retractile testicles are essentially testicles that can be brought down to the normal scrotal position, and stay down, until they are stimulated to retract again by a hyperreflexic cremasteric reflex.  Retractile testicles are essentially considered to be descended and therefore normal.  
It would be difficult to say whether physicians in the U.S. are undertreating retractile testicles or not, since they are by definition considered retracted and therefore normal.  Either your son has undescended testicles which would require surgical intervention at this time, or they are normal (or retractile) and only require observation.  If a testicle is normal (or retractile), then undertreatment would not be an issue.  
When your son’s urologist favored watching every year to see if the testicles descend, was there a question of whether they are undescended or not?  If so, then your concerns may be warranted.  However, if he/she and you are sure that they are descended (retractile or not), then there should not be a concern for future testicular cancer, etc.  I hope this sheds some light on your situation.  Wish you the best.
This information is provided for general medical education purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653 6568).
Sincerely,
HFHS M.D.-JJ
*Keyword: retractile testicle, cryptorchidism, undescended testicle