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Summary

Orchiopexy is a surgical procedure that is done to place an undescended testicle inside the scrotum. Normally, the testicles of a baby move down into the scrotum at the end of a pregnancy. However, if they don’t, even six months after birth, an orchiopexy is performed. The surgery will prevent the risks of infertility, testicular cancer, or hernia in the future.

Before the procedure, the doctor will check your child and order a few diagnostic tests like ultrasound or blood/urine test. Your son will need to fast starting from midnight before the surgery. You will have to sign a consent form to permit your child’s operation. The procedure will be done under general anaesthesia and may take about an hour. If your child has no other health issues, he may be allowed to go home on the same day of the surgery. Wearing loose trousers and underwear may help reduce his discomfort. 

  1. What is orchiopexy?
  2. Why is orchiopexy recommended?
  3. Who can and cannot get orchiopexy?
  4. What preparations are needed before orchiopexy?
  5. How is orchiopexy done?
  6. How to care for yourself after orchiopexy?
  7. What are the possible complications/risks of orchiopexy?
  8. When to follow up with your doctor after an orchiopexy?

Orchiopexy is surgical procedure that is done to place an undescended testicle inside the scrotum.

Testicles (testes) are a pair of organs that produce sperm and testosterone (the male sex hormone). They are present inside the scrotum, a sac-like pouch beneath the penis. Scrotum keeps the testicles cooler than the body temperature - this is essential for sperm growth. 

Testicles are formed inside the lower abdomen while the baby is inside the womb. After birth, testicles descend into the scrotum. If they don’t descend immediately before birth, they will eventually in the first three to six months of life. This happens naturally without any treatment. However, if your baby’s testicles fail to drop in his scortum by six months, the surgeon may suggest an orchiopexy. It is preferred to perform this procedure before a baby is one year of age to avoid complications in future.

The surgery is done to avoid the following risks in future:

  • Testicular cancer
  • Infertility 
  • Development of hernia (bulging of an organ or tissue from an abnormal opening in the muscle) in the groin
  • Testicular torsion (twisting of the cord that supplies blood to the scrotum) 
  • Low self-esteem and confidence 
  • Testosterone deficiency

An orchiopexy is contraindicated in individuals with:

  • Segmental vas atresia or a detached epididymis (a condition that prevents blood flow to the testes) 
  • Previous abdominal surgery that has caused adhesions in the abdominal wall

Before this surgery, you will need the following preparation:

  • Your octor will conduct a physical exam and order the following tests to check your baby's overall health:
  • Tell your doctor if your child takes any medications. The doctor may ask you to stop a few medicines for a week before the surgery.
  • Notify the doctor if your child has a pacemaker, mechanical heart valve, or methicillin-resistant Staphylococcus aureus (MRSA) infection.
  • Your child will have to abstain from food after midnight before the surgery. He will be allowed to drink clear liquids like water, breast milk, or juices for up to two hours before the surgery.
  • If you agree to the procedure, you will be asked to sign a consent form.

Before the surgery, the doctor administers general anaesthesia to your childn keep him asleep and pain-free during the operation. The surgery will be done in the following way:

  • The surgeon will either make a cut or several small cuts (in laparoscopic surgery, where a flexible, slender tube with a light source and camera at its tip is used) in the groin area of the child.
  • He/she will locate the undescended testicle/testicles and the cord that holds them inside the scrotum and separate the cord from the surrounding tissues to help extend the testes and reach the scrotum. 
  • Then, the surgeon will make a minor cut in the child’s scrotum to create a pouch. 
  • He/she will place the testicles inside the scrotum pouch. 
  • Finally, the surgeon will stitch the child’s testicles in place, and close the surgical cuts using dissolvable stitches.

The surgery may take about an hour for one testicle. After the surgery, your child will be monitored carefully until he wakes up and will be discharged on the same day as the surgery. However, in case your child has some other medical conditions, his hospital stay may extend.

Once your child is home, you will have to take the following care:

  • Medications: 
    • You can give your child painkillers like paracetamol to reduce his pain after the surgery. However, consult your doctor for the proper dose and duration of the medicine. 
    • The doctor may also prescribe antibiotics (medications to destroy microorganisms that cause infection) and antiemetics (to prevent vomiting).
  • Bathing/showering:
    • Do not give your child a bath for at least a week after the procedure. Instead, gently clean him with a fresh cloth and lukewarm water.. 
    • Do not use scented soaps.
  • Wound care:
    • Keep the surgical area clean and dry until it heals.
    • If your child still wears nappies, make sure change them repeatedly. Otherwise, loose trousers and underwear can reduce the discomfort at the surgical site..

When to see the doctor?

Visit or call your child’s doctor immediately if he experiences the following symptoms after the surgery:

  • Fever
  • Chills
  • Loss of appetite 
  • Stomach pain 
  • Fatigue 
  • Increase in the intensity of pain 
  • Difficulty in urinating 
  • Continuous nausea or vomiting 
  • Swelling, bleeding or bruising at the incision site
  • Change in smell, appearance, volume, and frequency of urine
  • Pus, redness, or tenderness around the surgical site

This surgery possesses the following risks:

  • Infection 
  • Allergy to certain medications or anesthesia used during the procedure
  • Bleeding 
  • Breathing problem 
  • Testicular atrophy
  • Inability to bring the testes inside the scrotum

A follow-up visit will be scheduled six to eight weeks after the surgery where the doctor will check the cosmetic outcome of the procedure.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.

References

  1. Beth Israel Lahey Health: Winchester Hospital [Internet]. Winchester. Maryland. US; Orchiopexy—Open Surgery
  2. Urology Care Foundation [Internet]. American Urological Association. Maryland. US; What are Undescended Testicles (Cryptorchidism)?
  3. National Health Service [Internet]. UK; Undescended testicles
  4. Better health channel. Department of Health and Human Services [internet]. State government of Victoria. Australia; Undescended testicles
  5. Burgu Berk. et al. Pediatric Urology. [Published on Dec 1, 2010] Chp 43. Cryptorchidism. Pg no 563-576
  6. Jameson JL, et al, eds. Endocrinology: Adult and Pediatric. 6th ed. Philadelphia, PA: Elsevier Saunders; 2013
  7. Chung DH. Pediatric surgery. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 20th ed. Philadelphia, PA: Elsevier; 2017:chap 66.
  8. Elder JS. Disorders and anomalies of the scrotal contents. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 560.
  9. Barthold JS, Hagerty JA. Etiology, diagnosis, and management of the undescended testis. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 148.
  10. West Suffolk: NHS Foundation Trust [Internet]. National Health Service. UK; Orchidopexy in children
  11. Queensland Health [Internet]. Queensland Government. Australia; Orchidopexy
  12. Srinivasan A, Ghanaat M. Laparoscopic orchiopexy. In: Bishoff JT, Kavoussi LR, eds. Atlas of Laparoscopic and Robotic Urologic Surgery. 3rd ed. Philadelphia, PA: Elsevier; 2017:chap 42.
  13. Children's Hospital of Los Angeles [Internet]. California. US; Care of your child after orchiopexy surgery
  14. Royal Berkshire Hospital [Internet]. NHS Foundation Trust. National Health Service. UK; Orchidopexy
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