Orchiopexy

Overview

Orchiopexy, also referred to as orchidopexy, is a surgical procedure to move a testicle from the groin area (inguinal region) into the scrotum, the pouch of skin behind the penis where the testes are typically located. The term is also commonly used to describe surgery aimed at correcting testicular torsion and preventing its recurrence. The procedure generally takes less than an hour to complete and often yields permanent results. However, there are some associated risks, including bruising, infection, and healing complications. Recovery usually takes around two weeks or longer, depending on the individual’s healing process.

Reasons for undergoing the procedure

An orchiopexy addresses two primary conditions:

• Undescended testicles: During fetal development, the testicles form in the abdomen of a male fetus and are expected to descend into the scrotum before birth. However, in some cases, the testicles do not move into the scrotum either before birth or within the first few months of life, resulting in a condition known as cryptorchidism, or undescended testicles.
  
  Approximately 3% of newborns are born with undescended testicles, and this condition is even more common among premature babies, affecting up to 30% of them. An orchiopexy is the surgical procedure used to address this issue. A unilateral orchiopexy corrects one undescended testicle, while a bilateral orchiopexy addresses both.If undescended testicles do not resolve on their own after birth, it is generally recommended that the child undergoes an orchiopexy between 12 and 24 months of age to ensure proper testicle placement and function.

• Testicular torsion: Testicular torsion is a serious and painful condition where the spermatic cord, which supplies blood to the testicle, becomes twisted. This twisting impairs blood flow, potentially leading to severe pain and damage. Testicular torsion affects approximately 1 in 4,000 individuals under the age of 25, making prompt treatment crucial.
  
  If you or your child experiences symptoms of testicular torsion, immediate surgical intervention is necessary. Should blood flow not be restored to the affected testicle within six hours, there is a risk that the testicle may need to be surgically removed. Early intervention is essential to preserve testicular health and function.

Risks

In rare cases, a testicle may move out of the scrotum after an orchiopexy, a condition known as a reascending testicle. This situation necessitates further surgical intervention to secure the testicle in its proper position.

As with any surgical procedure, an orchiopexy carries inherent risks. Potential complications may include:

• Anesthesia reaction.
• Infection.
• Swelling.
• Bruising.
• Hematomas or formation of clotted blood.
• Problems with healing.
• Unfavorable scarring.

Before the procedure

Prior to an orchiopexy, you will have a consultation with your healthcare provider, who will assess you or your child’s overall health. This evaluation will include checking vital signs such as temperature, pulse, and blood pressure.

Inform your healthcare provider about all prescription and over-the-counter medications, including any herbal supplements that you or your child are taking. Some medications, such as aspirin, anti-inflammatory drugs, and certain herbal supplements, can increase the risk of bleeding during and after the procedure.

To minimize the risk of infection, make sure to thoroughly clean your groin area both the day before and the morning of the procedure.

Your healthcare provider will provide specific instructions, including not consuming any food or beverages after midnight the night before the procedure. If you need to take prescription medications, do so with a small sip of water.

During the procedure

The pediatric anesthesiologist will administer general anesthesia to your child, ensuring they are fully unconscious and immobile, so they do not feel any pain. Once your child is asleep, the pediatric surgeon will make a small incision in the groin using a sterile scalpel to locate and access the undescended testicle and the spermatic cord. 

The surgeon will then examine the testicle to determine its health; if the testicle is damaged and needs to be removed, a testicular prosthesis may be inserted. Additionally, the surgeon will inspect the groin area and repair any hernia sacs that might be present. These occur when a section of the intestine pushes through an opening in the abdominal wall, forming a sac with fat or fluid.

The surgeon will also evaluate the spermatic cord to ensure it is long enough to allow the testicle to descend into the scrotum without strain. If necessary, the surgeon will adjust the hernia sac to provide adequate length for proper placement. The testicle will then be placed in a pocket called the Dartos pouch, created in the scrotum. A small gripping tool will be used to pull the undescended testicle into the pouch, where it will be secured with dissolvable sutures. 

Finally, the surgeon will close both incisions with dissolvable stitches. The entire orchiopexy procedure typically takes less than an hour.

During an orchiopexy for testicular torsion, the surgeon performs the following steps:

• A small incision is made in the scrotum.
• The surgeon untwists the spermatic cord and examines the testicle.
• If the testicle appears healthy, it is stitched to the scrotum to prevent future twisting.
• If the testicle appears unhealthy, it may be removed and replaced with a prosthetic testicle.
• The incision is then stitched closed.

After the procedure

After the orchiopexy procedure, your healthcare provider will cover the stitches with gauze or bandages to protect the area. The anesthesiologist will then stop administering anesthesia, allowing your child to start waking up. Once awake, your child will be moved to a recovery room where the healthcare team will monitor their vital signs and overall condition.

If the team determines that your child is stable and recovering well, you can expect to go home approximately two hours after the procedure.

Outcome

An orchiopexy offers several benefits, including:

• Fertility and health: The procedure can help prevent infertility by ensuring proper testicular placement. Research also indicates that it may lower the risk of developing testicular cancer in the future.
• Reducing risk of injury: Testicles that remain in the groin area are more susceptible to injury compared to those in the scrotum. An orchiopexy minimizes the risk of injury from sports, seat belts, tight clothing, and belts.
• Boost in self-esteem: As children grow older, they may feel self-conscious about having one or no testicles in the scrotum. An orchiopexy can improve their body image and self-esteem, as most patients appreciate the aesthetic and functional results of the surgery.
• Safety and recovery: An orchiopexy is generally a safe procedure with a low risk of complications or side effects. Most patients are able to return home on the same day as the surgery.

The following instructions will be provided to you.

• For managing mild pain after an orchiopexy, use children’s OTC NSAIDs like acetaminophen or ibuprofen, but consult your healthcare provider first. Apply an ice pack wrapped in a towel to the affected area for 10 minutes, at least four times a day, to reduce bruising and swelling.
• Post-surgery, your child may feel nauseous due to anesthesia. Stick to clear liquids and bland, soft foods to ease their stomach. 
• Ensure they rest and avoid strenuous activities to promote healing. Most children over 12 months can resume normal activities after two to three days but should avoid activities that strain the groin.
• Keep the incision area clean and avoid bathing your child in a tub for about a week. 
• Follow your provider’s specific care instructions and schedule follow-up appointments as recommended.

Contact your healthcare provider immediately if your child shows any of the following abnormal symptoms after an orchiopexy:

• Heavy bleeding at the incision sites.
• Infection.
• High fever.
• Increased pain.
• Swelling.