Orchiopexy for undescended testicle

Surgery Overview

Surgery to move an undescended testicle into the scrotum is called orchiopexy or orchidopexy. It is usually performed on infants and young boys who are between 6 months and 15 months old. In most cases, a pediatric surgeon or a specialist who treats urinary problems in children (pediatric urologist) performs the surgery.

Orchiopexy may also be done on older boys and, rarely, on teens and adult men who have undescended testicles. Untreated undescended testicles are usually removed in adult men and teens who have gone through puberty because of the increased risk of testicular cancer.

Depending on the location of the testicle, one or two small incisions are made in the scrotum, the groin, or the abdomen to allow the surgeon to reach the testicle and move it to the scrotum. Sometimes another surgical method called laparoscopy is used to move undescended testicles when they are located high in the inguinal canal or in the abdomen. In both types of orchiopexy, general anesthesia is used.

Usually only one surgery is needed. But in some cases where the testicles are located in the abdomen, orchiopexy may require two separate operations that are done several months apart. Sometimes an undescended testicle is surgically removed from the body and reimplanted in the scrotum (testicular autotransplantation), and the surrounding tissues and blood vessels are reattached.

What To Expect After Surgery

Orchiopexy can be done as an outpatient procedure or with a short hospital stay. The surgery for testicles that are located just above the scrotum and for testicles that are low in the inguinal canal is usually much simpler than for testicles that are higher up in the canal or in the abdomen. Uncomplicated orchiopexy surgery can often be done on an outpatient basis, meaning the child goes home the same day.

For at least 2 weeks after surgery, boys should avoid games, sports, rough play, bike riding, and other activities where there is a risk of an injury to the genitals.

The doctor will perform a follow-up exam usually within 2 to 3 months after the operation.

Why It Is Done

Orchiopexy is done to place an undescended testicle in its normal position in the scrotum.

• Placing undescended testicles in the scrotum may help prevent infertility.
• Treatment does not appear to reduce the risk of developing testicular cancer, but it makes it easier to find cancer if it develops.
• Surgery can boost a boy's self-esteem. An empty or partially empty scrotum can make a boy feel bad about himself and his body, especially during the teen years.

How Well It Works

Usually, the outcome of orchiopexy is good, and the testicle is moved into the scrotum. But success rates vary by where the testicle is located at the time the surgery is done. Success rates are:¹

• About 92% for testicles that are located just above the scrotum (prescrotal).
• About 80% to 90% for testicles that are located in the inguinal canal.
• About 74% for testicles that are located in the abdomen.

Risks

Possible complications for orchiopexy include:

• Infection.
• Bleeding or blood clots in the scrotum.
• Damage to the vas deferens and the blood supply to the testicle. Without an adequate blood supply, the testicle may shrink (atrophy).
• The testicle(s) moving out of the scrotum again (reascend) after surgery and requiring further treatment. This rarely happens.

What To Think About

Orchiopexy is considered a safe and reliable procedure that has relatively few risks. It is best to choose a surgeon and hospital staff who have training and experience in this procedure and in the special needs of children.

In some cases, the testicle is removed from the body entirely and then reimplanted in the scrotum (testicular autotransplantation). This procedure requires reattaching surrounding tissue and blood vessels. Sometimes the surgeon uses the blood vessels that supply the vas deferens to also supply the testicle in its new location. Talk with a doctor if you have had surgery for an undescended testicle and are now considering a vasectomy. During a vasectomy, the vas deferens is cut, and this could affect blood flow to a reimplanted testicle.

Some doctors recommend a testicular biopsy during orchiopexy if the undescended testicle is in the abdomen or if the child has genital defects, such as hypospadias, or a genetic disorder. In this test, a small sample of tissue is taken from the testicles and then examined for signs of cancer.

Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.

Author:	Debby Golonka, MPH	Last Updated: June 6, 2007
Medical Review:	Michael J. Sexton, MD - Pediatrics Peter Anderson, MD, FRCS(C) - Pediatric Urology
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