What is Orchiopexy?
Orchiopexy is a surgical procedure where the surgeon aims to fasten the undescended testicle inside the scrotum. This is normally done by using dissolvable sutures. This is often required to treat male infants or very young children to treat cryptorchidism (undescended testicle).
Orchiopexy is also performed on adolescents and adults. It may treat one or both testicles. Adults mostly require this procedure to treat testicular torsion. This emergency medical condition develops when the testicle gets twisted around the spermatic cord and loses blood supply.
Orchiopexy may also be called as Orchidopexy, inguinal orchiopexy, undescended testicle repair, and repair for cryptorchidism or as testicle torsion repair.
Why is an Orchiopexy performed?
An orchiopexy is performed mainly to treat undescended testicle conditions in male infants, younger children, adolescents and adults also. It is important to first know what the disorder entails before understanding the need and purpose of an orchiopexy.
Normally, cord-like ligaments (gubernaculums) are what attach the testes with the groin (inguinal) area in the male fetus. This holds true till the 7th month of pregnancy. In the period between the 28th and 35th week of pregnancy, the gubernaculums migrate into the stratum and create a space for the testes to descend.
At times, several factors may cause problems with the normal descending of the testicle, at the time of birth. The factors include the decreased secretion of male hormone (androgen), defective genital nerves, and structural abnormalities in the genitals of the boy.
There are several reasons why children may require an Orchiopexy procedure, these include:
Minimizing infertility risk – Typically, adult males with cryptorchidism have an abnormally lowered sperm count and the quality of semen in also found to be affected. This increases the risk of infertility with age, especially when both the testicles are affected. Research studies show that men with a single undescended testicle are at around 40% risk of infertility while those men with both testicles undescended have a 70% risk of infertility.
Decrease testicular cancer risk – Malignant tumors in undescended testicles are found 48 times more than in normal testes. There is also a 10% chance of developing testicular cancer due to this condition.
Lower risk of severe trauma to testicles – Undescended testicles are vulnerable to injuries and trauma from sports or accidents.
Prevent inguinal hernia – An undescended testicle may also result in part of the abdomen pushing through the valve through which normally the testicle descends from the abdomen into the scrotum. This causes inguinal hernia to develop.
Prevent testicle torsion in adult males
Make scrotum appear normal
The treatment of testicular torsion in adult males remains the condition which mostly requires an orchiopexy. A complete orchiectomy is normally advised in case testicle remains undescended after the male child has reached the age of puberty.
What type of diagnosis is used for recommending an Orchiopexy?
The diagnosis of cryptorchidism is usually done when a pediatrician is performing a routine physical examination of a male infant or child. The condition may also be noticed at an older age before the age of puberty. The doctor performs extensive physical evaluation of the child’s genital (scrotum) to determine whether both testicles have descended normally.
In case the doctor determines that there is suspicion of an undescended testicle, a pediatric urologist may be consulted before advising orchiopexy for the child. Apart from an extensive physical examination, the doctor may also perform an inguinal procedure with a laparoscopic approach (minimally invasive surgical technique) to check the inner groin area for the location of the undescended testicle. Once the location of the undescended testicle is determined then the pediatrician may advise to undergo an orchiopexy procedure to correct this condition.
Diagnosing testicular torsion is done mostly in the emergency room. A sharp and sudden pain on one side of the scrotum indicates towards testicular torsion. Excessive hard work, strenuous exercising and trauma to the genital area usually result in this condition. At times, the testicular torsion may also occur without any apparent reason.
Symptoms of this condition may also include:
Swelling in the scrotum
Blood in semen
There may also be frequent urination need. The doctor also finds the affected side of the scrotum to have become enlarged and painful to touch. The affected testicle may also be noticeably higher placed than the normal testicle and may also be placed in a horizontal position.
Since this condition is termed as a medical emergency, there might not be time to perform detailed imaging tests for it. In case of an unclear diagnosis, however, the doctor may recommend a radionuclide scan or color Doppler ultrasound test to check the status of blood flow to the affected testicle. A mild sedative or painkiller is administered to the patient before the surgery to alleviate the pain felt in this condition.
What does the aftercare of an Orchiopexy involve?
For cryptorchidism –
For children, aftercare depends mainly on the level of complexity of the surgery, In case of simple and uncomplicated orchiopexy, the child is discharged from the hospital on the same day. In case the surgeon makes an incision to find a non-palpable testicle, the child will usually be sent home in 2 to 3 days. Safe painkillers will be prescribed for a few days.
At home, the child should not bathe till the next day following the surgery. Apart from this, the child should also refrain from riding a bicycle and other things that require straddling, for around 2 to 3 weeks. Older children should avoid full-contact and rigorous sports activities which can result in injury to the testicle.
A follow up appointment will also be scheduled, for 1 or 2 weeks after the procedure, along with an additional checkup around 3 months later.
For testicular torsion –
Caring for the child following an orchiopexy testicular torsion and cryptorchidism are similar. After cleaning the area around the incision wound gently the day following the surgery, apply fresh dressing. Painkillers are prescribed for a few days following the surgery. Several days of rest at home are also advised normally. Apart from this, the patient is advised to increase fluid intake and to keep the scrotum elevated using a soft small support. This helps to ease any discomfort. Sexual activity and rigorous exercise are also to be refrained from until the swelling subsides and the pain is gone.
What are the risks associated with Orchiopexy?
For Cryptorchidism –
These are the risks associated with treatment of cryptorchidism using Orchiopexy:
Infection in incision
Vascular damage (also spermatic cord damage) leading to eventual loss of testicle
Testicle ascending (requires a repeat procedure to correct)
Difficult urination for few days
For Testicular Torsion
These are the risks associated with orchiopexy when used as treatment for testicular torsion:
Infection in incision
Loss of blood supply, leading to loss of testicle