Orchiopexy is a surgical procedure for an undescended testicle, a condition known as cryptorchidism. During fetal development, a male’s testicles form inside the abdomen and move down into the scrotum before birth. When one or both testicles fail to complete this descent, orchiopexy is performed to move the testicle into its proper position within the scrotum and secure it. This pediatric operation is recommended if the testicles do not descend on their own within the first several months of life.
Understanding the Need for Orchiopexy
The primary reason for orchiopexy is that the scrotum’s location outside the main body cavity maintains a temperature slightly lower than core body temperature. This cooler environment is important for the normal development of testicles and for future sperm production. When a testicle remains in the warmer abdomen or groin, it can impair its growth and ability to produce healthy sperm, potentially affecting fertility.
An undescended testicle is associated with long-term health considerations. The risk of developing testicular cancer is higher in men born with an undescended testicle, even after corrective surgery. However, relocating the testicle to the scrotum makes monitoring and self-examination for any abnormalities much easier. An undescended testicle is also more susceptible to testicular torsion, a painful twisting of the spermatic cord that cuts off blood supply.
In many infants, the testicles will descend into the scrotum without intervention within the first three to six months of life. For this reason, physicians often adopt a “watchful waiting” approach initially. If the testicle has not descended by the time the child is about six months old, surgery is recommended. The procedure is ideally performed before the child reaches 12 to 18 months of age to support testicular health.
The Surgical Procedure
Patients are required to fast for a set number of hours before the operation to prepare for general anesthesia. General anesthesia ensures the child is asleep, relaxed, and feels no pain during the procedure. The surgery is a routine outpatient procedure that takes about an hour to complete.
The surgeon’s approach depends on the location of the undescended testicle. For a testicle located in the groin (an inguinal testicle), the surgeon makes a small incision in the groin area. Through this opening, the surgeon frees the testicle and the spermatic cord from surrounding tissues. This ensures there is enough length for the testicle to reach the scrotum without tension on its blood supply.
If the testicle is located higher in the abdomen, a laparoscopic technique may be used. This approach involves inserting a small camera and surgical tools through tiny incisions to locate and bring down the testicle. Regardless of the approach, a second small incision is made on the scrotum to create a small pouch. The testicle is then guided into this pouch and secured with dissolvable stitches to ensure it remains in the correct position.
Post-Operative Care and Recovery
Following the surgery, care focuses on ensuring the child is comfortable and the incision sites heal properly. Pain can be managed with over-the-counter medications like acetaminophen or ibuprofen, as recommended by the healthcare provider. The scrotum will likely be swollen and bruised, which is normal and can be managed with brief, cloth-wrapped ice pack applications.
Parents will receive specific instructions on how to care for the incisions. The stitches used are dissolvable and do not need to be removed. Bathing is permitted a day or two after the procedure, and gentle washing of the area can help with healing.
Activity restrictions are a part of the recovery process for the first few weeks. Children should avoid:
- Rough play
- Contact sports
- Jumping
- Straddle toys, such as bicycles or rocking horses, for about two to three weeks to prevent pressure on the surgical area.
Most children can return to school or daycare within a few days, but physical education classes should be postponed. A follow-up appointment with the surgeon is scheduled to monitor healing and confirm the testicle remains properly positioned.