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Orchidopexy
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.
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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.
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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.
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Your Consultation
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.
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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.
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Recovery
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.
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Risks
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.
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Frequently Asked Questions
Q:
Why should one get an orchidopexy?
A:
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)
Q:
What occurs during this procedure?
A:
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.
Q:
What are the indications of this condition?
A:
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.
The following list of Urology procedures are
performed at Beverly Hills Medical Group -
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