Cremasteric reflex and retraction of a testis

Purpose: A clinical study has been planned to define the clinical character istics of cremasteric reflex (CR) for deciding on the possibility of a prol onged suprascrotal stay of a testis through this reflex. Methods: Five hundred boys from 3 days to 16 years of age were divided into 6 groups according to their ages and were evaluated for the presence of th e CR. After evoking CR, the presence or absence of changes in testicular lo cation and the most elevated position of the testis were recorded. Testicul ar position difference (TPD), the duration of the stay of testis in the mos t elevated position (DEP), and the interval for reevoking the CR (IRCR) wer e determined. The number of consecutive responses after repetitive evokings were recorded as reproducibility (R). Mean TPD, DEP, IRCR, and R values fo r both sides were calculated and compared among groups. The boys with a pos itive reflex were classified further according to their TPD, DEP, IRCR, and R values. Three groups were established according to the aforementioned cr iteria by dividing the values into 3 equal parts. The association of each o f the parameters to other parameters were compared. Results: Bilateral positive CR was encountered in 42.7% of newborns, 36.3% of the boys between 1 month and 1 year old, 38.1% of the boys between 2 yea rs and 4 years old, 75.2% of the boys between 5 years and 8 years old, 70.3 % of the boys between 9 years and 12 years old, and 72.1% of the boys betwe en 13 and 16 years old. The highest percentage of the contralateral activat ions during ipsilateral evokings were encountered in boys who were between 5 and 8 years of age. The highest mean TPD and mean R, the longest mean DEP , and mean IRCR were encountered in boys between 5 and 8 yea rs of age. Boy s with the highest TPD did not have shortest IRCR and highest R values. Sim ilarly, boys with the longest DEP or shortest IRCR and highest R values did not have the association of other parameters that would suggest a hypersen sitivity. Conclusions: The rate of presence and the characteristics of a positive CR vary largely. However, suprascrotal location of a testis for extended perio ds through the activation of this reflex does not seem to be likely. Instea d of a hyperactive reflex, the clinical condition, so called the retractile testis, might have resulted through alterations within the cremaster muscl e itself. J Pediatr Surg 36:863-867. Copyright (C) 2001 by W.B. Saunders Co mpany.