Un testicolo retrattile o ascendente indica un testicolo in grado di muoversi da solo o su stimolazione tra la sacca dello scroto e l’inguine. Tendenzialmente non deve preoccupare, soprattutto nel bambino, anche perché nella maggioranza dei casi non ha conseguenze e si risolve con la pubertà. Ma vediamo meglio nel dettaglio cosa fare.
Come si fa la diagnosi di un testicolo retrattile
Un testicolo retrattile in genere non comporta dolore, ma può essere visibile e palpabile all’altezza dell’inguine o cambiare posizione (da qui allo scroto e viceversa) spontaneamente o su manipolazione. Il pediatra controlla sempre durante le visite gli organi genitali del bambino ed in questo caso potrà notare l’organo non sceso. Se con una lieve manovra riesce a spostarlo nel sito giusto, ovvero la sacca scrotale, si è in presenza di un testicolo retrattile (o “in ascensore”), che è diverso dal testicolo ritenuto (criptorchidismo) in cui questo passaggio non è possibile. Tale controllo si può fare con il bambino sia sdraiato che seduto o in piedi. Ragazzi più grandi possono essere invitati ad accovacciarsi. Questa posizione rende più facile trovare e manipolare il testicolo. Inoltre, è importante che questo esame venga fatto in un luogo caldo e che il medico abbia le mani calde, perché il freddo può stimolare il riflesso cremastere (che fa salire il testicolo).
Se il testicolo è retrattile, come dicevamo, si sposta in modo relativamente semplice e indolore e può rimanere fermo nel nuovo sito. Il medico a quel punto potrà stimolare il riflesso del muscolo cremastere strofinando delicatamente la parte interna superiore della coscia. Questa stimolazione di solito causa la risalita del testicolo retrattile.
Se il testicolo nell’inguine si muove solo parzialmente nello scroto, se il movimento provoca dolore o fastidio, o se il testicolo si ritira immediatamente alla sua posizione originale, è più probabile che non si tratti un semplice testicolo retrattile, ma di un ascendente.
Raggi X, ecografia e risonanza magnetica non sono generalmente utili per determinare se i testicoli sono retrattili o meno.
Trattamenti e farmaci
Un testicolo retrattile in genere si risolve da solo prima o durante la pubertà. Importante sarà dunque fino a quel momento monitorare eventuali cambiamenti della sua posizione nelle valutazioni annuali per determinare se rimane nello scroto, rimane retrattile o diventa un testicolo ascendente.
Se il testicolo è salito – non più mobile a mano – o se è ancora retrattile dopo i 14 anni, il pediatra può raccomandare un trattamento per spostarlo in modo permanente nello scroto. Le terapie al riguardo includono:
- Chirurgia. In una procedura chirurgica (orchiopexy), il chirurgo guida il testicolo alla sua posizione corretta nello scroto e cuce in posizione. Esami di follow-up sono di solito raccomandati.
- Terapia ormonale. Poiché la discesa del testicolo è parzialmente regolata da ormoni, questa a volte può essere indotta con una terapia ormonale a base di gonadotropina corionica umana (hCG) in iniezioni.
Ragazzi adolescenti e uomini adulti che hanno avuto trattamenti per correggere un testicolo ascendente o retrattile dovrebbero sempre monitorare regolarmente la posizione del testicolo per assicurarsi che non cambi.
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