What is Orchidopexy?
The removal of a testicle into its normal position within the scrotal sac and have it fixed there is called an orchidopexy. This is a quick operation wherein two small cuts are created in the scrotal sac and the groin where the surgery takes place.
Effects of Orchidopexy
Reducing malignant potential or increasing fertility are not the compelling reasons for orchidopexy. This procedure results in the reduction of the risk of trauma and torsion. It also improves the recognition of malignancy if it does occur.
Candidates for Orchidopexy
Patients with undescended testicles must have a monthly examination throughout life in order to identify the possibility of tumor development. There is a 30- to 50-fold higher rate of testicular cancer in individuals with undescended testes than those whose testicular development is normal.
Six hours prior to the procedure, the patient is no longer allowed to eat or drink anything, even a sip of water. The stomach must be empty in order to ensure a safe administration of the anesthetic. In the event that the patient gets a cold, it is important to inform the doctor as the operation may need to be postponed. The patient should overcome the cold first before undergoing the procedure as having an anesthetic could make the cold into a serious infection in the chest.
Make sure that all medicines, including tablets and inhalers that the patient is using should be sorted and placed in their original packets or boxes. These medications should be brought to the hospital. Once there, the patient will be checked for past illnesses and may undergo special tests in order to be absolutely positive that the patient is ready and that we can safely proceed with the surgery. At the present time, most hospitals have a preadmission clinic where the patient can visit and have these checks a week or so before undergoing the operation.
The Orchidopexy Procedure
The procedure will be done under general anesthesia so the patient will be completely asleep. A cut is then created overlying the groin or the inguinal area. Sometimes, there is a small hernia present just next to the testicle which is a weak spot or gap in the muscles in the front of the tummy. This is fixed and then closed with sutures. Once the testicle is found, its artery which give blood and its vein which drains the blood, together with the connecting tubes, are freed off as much as possible. This will make them long enough to let the testicle sit in the scrotum free from any tension. Another cut is created in the scrotum and a little space is made under the skin and the supporting tissues of the skin. With stitches made in the scrotum, the testicle is fixed and put in its proper place. Finally, the skin is stitched up in both places. An orchidopexy usually takes about 20 minutes on each side.
The patient will be admitted and discharged on the same day as the orchidopexy. Arrangements should be made for someone to drive the patient home from the hospital as general anesthesia or sedation will be administered and driving a car, drinking alcohol, or operating machinery 24 hours after the procedure is not allowed.
Once the patient is discharged home from the procedure, pain and/or discomfort at the wound site may be experienced by the patient several days postoperatively. Painkillers may be prescribed or recommended to give some relief. Wearing supportive underpants and loose trousers may give some comfort to the patient. A small amount of swelling, as well as a minimal bruising after orchidopexy may be experienced. It is important to have as much rest as possible with the legs elevated in order to hasten healing and for the reduction of any likely swelling of the scrotal area. If antibiotics are prescribed, make sure that you take the whole course given as instructed.
Bathing or showering may be done 24 hours after the surgery. Allow the water to soak off the wound dressing as you bathe or shower. On the other hand, the use of bubble baths and/or scented soaps should be passed up. The stitches will not be requiring any removing as these will dissolve in approximately two to three weeks. Nevertheless, make sure that this is the case before discharge from the hospital.
When the patient feels comfortable to resume work and is confident to be able to manage with the activities that ones job requires, then he may resume work. Sex should be avoided until the wound has completely healed and that there is no more pain felt.
Swelling and some erythema or redness around the wound area may be experienced but they usually resolve in three to four days. Bleeding does not usually happen and is rarely a problem. If ever there is some bleeding, this can be relieved by applying extra pressure on the wound area. In extremely rare cases, an operation may be needed to stop the bleeding. There may be the problem of infection in the wound area although this is a rare problem. This can be resolved in one or two weeks by taking antibiotics. Swelling of the testicle may also be experienced on rare instances and like an infection, this can be resolved by taking antibiotics for a week or two. It usually takes a month for the stitches to fall out of the wound. This really happens and should not be a cause for any trouble for the patient.
There are occasions wherein the testis does not reach the scrotum after the first surgery. Because of this, the orchidopexy needs to be repeated. Although very rare, if the testicle is very high in the abdomen or the blood supply to the testis is poor, there is a possibility for this to shrink and disappear.
Why should one get an orchidopexy?
Three months following birth, the testes descend by themselves. If this does not occur, an operation called an orchidopexy is then required. The best age to undergo this procedure is controversial and should be first discussed thoroughly with a specialist. However, a lot of experts suggest between 6-12 months of age. This procedure is advised to be done when the testes do not descend by themselves as this results in a great risk for ongoing health issues such as:
- Hernia wherein there is a lump of bowel coming through the same holes as the testis
- Lower fertility as the body temperature in the abdomen is higher than in the scrotum and can therefore affect the sperm production in the testes.
- Low self-esteem as this is also a cosmetic problem
- Risk of testicular cancer
- Trauma such as twisting (torsion)
What occurs during this procedure?
Since this procedure is done in order to bring the testis down into its normal location in the scrotum, a small cut is made in the inguinal or groin area. The testis is then stitched in the scrotum and will remain in the scrotum after a successful operation. This procedure can be done as an outpatient and the patient may go home the same day as the orchidopexy.
What are the indications of this condition?
This surgery is indicated for infants older than 1 year who are suffering from cryptorchidism or whose testicles have not descended into the scrotum. Usually, undescended testicles often descend into the scrotum by age 1. It is very rare that testicles descend on their own after age 1.
Cryptorchidism is more common in premature babies. This usually affected only one side. Undescended testicles may cause infertility and one is more prone to develop malignant tumors in later years.