title: Surgical Management of the Adult Symptomatic Retractile Testicle.
abstract: OBJECTIVE
  To assess the efficacy and safety of circumferential cremasteric lysis in the treatment of adult symptomatic retractile testicles.
  
  
  METHODS
  This is a retrospective chart review of all patients who had undergone circumferential cremasteric lysis at a single institution performed by a single surgeon between January 2010 and December 2011. We evaluated the etiology, pre- and postoperative pain intensity, postoperative pain alleviation, and any surgical complications. We used the Wilcoxon signed-rank test to compare pain levels before and at last follow-up after surgery.
  
  
  RESULTS
  Eight patients (mean age, 31.5 ± 10.60; range, 22-51 years) underwent circumferential cremasteric lysis. The procedure resulted in a clinically meaningful and statistically significant difference in postoperative pain intensity. The mean pain levels decreased from 5.6 (preoperatively) to 1.5 (at last follow-up) (5.6 vs 1.5, P < .01, Wilcoxon signed-rank test). The mean follow-up was 21.63 ± 13.70 months (range, 9-50 months). Four patients (50%) reported complete resolution and four (50%) reported partial resolution of their testicular pain at last follow-up.
  
  
  CONCLUSIONS
  In this limited retrospective study, we demonstrated that circumferential lysis of the cremasteric muscle through a small subinguinal incision is a safe and effective minimally invasive procedure for physical activity-precipitated painful retractile testicular pain.
authors.affiliation: Urology Service, Walter Reed National Military Medical Center, Bethesda, MD. Electronic address: davidjosborn@hotmail.com.
authors.forename: David James
authors.initials: DJ
authors.lastname: Osborn
authors.affiliation: Urology Service, Walter Reed National Military Medical Center, Bethesda, MD.
authors.forename: Andy J
authors.initials: AJ
authors.lastname: Martinez
authors.affiliation: Urology Service, Walter Reed National Military Medical Center, Bethesda, MD.
authors.forename: James R
authors.initials: JR
authors.lastname: Jezior
mesh_terms: D000009:Abdominal Muscles / Q000601:surgery*; D000328:Adult; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010146:Pain / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013733:Testicular Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult