Orchiopexy is a common surgical procedure performed to correct an undescended testicle. The operation involves moving a testicle that has failed to reach its normal position in the scrotal sac. Once relocated, the testicle is permanently secured within the scrotum to prevent it from returning to the groin or abdomen. Diagnosed most often in infancy, orchiopexy is one of the most frequently performed procedures in pediatric surgery. The surgery is typically completed before a child reaches 18 months of age.
The Medical Condition Requiring Orchiopexy
The condition that necessitates orchiopexy is known as Cryptorchidism, which describes the absence of one or both testicles in the scrotum. This occurs because the testicles, which form inside the abdomen during fetal development, fail to complete their descent into the scrotum by the time the infant is about six months old. While some spontaneous descent can occur in the first few months of life, it is rare after six months, making surgical intervention necessary.
Leaving a testicle in an undescended position is harmful because the higher body temperature inside the groin or abdomen damages the germ cells that produce sperm. Normal sperm production requires a temperature slightly cooler than the core body temperature, which the scrotum provides. If left untreated, this can lead to a significant reduction in fertility later in life.
The testicle may be found in various locations along the natural path of descent, most commonly in the inguinal canal. In a smaller number of cases, the testicle remains higher up within the abdominal cavity. A physical examination is the primary method for diagnosis, with imaging sometimes used to locate a testicle that cannot be felt. Surgical correction is recommended between 6 and 18 months of age to maximize the preservation of future testicular function.
Performing the Surgical Correction
Orchiopexy is generally performed as an outpatient procedure under general anesthesia, meaning the patient returns home the same day. The specific technique depends on the testicle’s location, but a standard approach utilizes a small incision in the groin area. Through this incision, the surgeon locates the undescended testicle and the spermatic cord, containing the blood vessels and the vas deferens.
The first objective of the surgery is mobilization, which involves carefully separating the spermatic cord and testicle from surrounding tissues to lengthen the cord. This step ensures the testicle can be brought down without tension, a requirement for healthy blood flow. A separate, smaller incision is then made in the scrotum to create a pouch beneath the scrotal skin.
For testicles located high within the abdomen, a different technique may be required, often involving laparoscopy. This minimally invasive approach uses a small camera to locate the testicle inside the abdomen. Sometimes, a two-stage procedure, such as the Fowler-Stephens technique, is necessary if the blood vessels leading to the testicle are too short to allow for a single-stage descent. In the final step, the testicle is gently guided into the scrotal pouch and secured with dissolvable sutures, a process called fixation, which prevents the testicle from retracting back up.
Post-Operative Care and Recovery Timeline
Following the procedure, patients are monitored until the effects of the general anesthesia wear off and they are stable enough to go home, usually within a few hours. Pain management is typically handled with non-prescription pain relievers like acetaminophen or ibuprofen, though a local anesthetic block is often administered during the surgery to control initial discomfort. Parents can expect their child to feel some mild pain or soreness for three to seven days.
Incisions are often closed with dissolvable stitches or skin glue, which will fall off naturally within two to three weeks. Swelling and minor bruising in the groin and scrotal area are normal and should gradually subside over the first couple of weeks. Wound care involves keeping the incision sites clean and dry; bathing restrictions may vary, sometimes limiting immersion for a week or two.
Activity restrictions are put in place to protect the surgical site and the newly fixed testicle. Children should avoid rough play, contact sports, and activities that involve straddling, such as riding tricycles or rocking horses, for about two weeks. Parents should watch for signs of complications, including fever, excessive redness, a foul-smelling discharge from the incision, or unrelieved pain, and seek immediate medical advice.
Long-Term Monitoring and Expected Outcomes
The overall success rate of orchiopexy in achieving permanent scrotal positioning is very high, often cited at over 95%. This successful placement significantly improves the chances of future fertility, especially when only one testicle was undescended and the surgery was performed within the recommended timeframe. Early correction helps preserve sperm-producing cells, which suffer cumulative damage from prolonged exposure to higher temperatures.
While the surgery reduces the risk of testicular injury and torsion, it does not eliminate the patient’s slightly elevated lifetime risk of developing testicular cancer. The primary benefit regarding malignancy is that placing the testicle in the scrotum makes it easily accessible for physical examination. This allows for early detection of any suspicious changes through self-examination, a practice patients should be taught as they reach adolescence.
Lifelong monitoring is necessary to ensure the testicle remains in the correct position and to track its growth and health over time. Follow-up appointments are scheduled in the immediate post-operative period and then periodically as the child grows to assess the surgical outcome. Patients who had bilateral undescended testicles may face a greater risk of infertility, but early orchiopexy remains the most effective intervention to optimize their long-term reproductive health.