Orchiopexy

Orchiopexy is surgical procedure that is done to place an undescended testicle inside the scrotum.

Testicles (testes) are a pair of organs that produce sperm and testosterone (the male sex hormone). They are present inside the scrotum, a sac-like pouch beneath the penis. Scrotum keeps the testicles cooler than the body temperature - this is essential for sperm growth. 

Testicles are formed inside the lower abdomen while the baby is inside the womb. After birth, testicles descend into the scrotum. If they don’t descend immediately before birth, they will eventually in the first three to six months of life. This happens naturally without any treatment. However, if your baby’s testicles fail to drop in his scortum by six months, the surgeon may suggest an orchiopexy. It is preferred to perform this procedure before a baby is one year of age to avoid complications in future.

The surgery is done to avoid the following risks in future:

• Testicular cancer
• Infertility 
• Development of hernia (bulging of an organ or tissue from an abnormal opening in the muscle) in the groin
• Testicular torsion (twisting of the cord that supplies blood to the scrotum) 
• Low self-esteem and confidence 
• Testosterone deficiency

An orchiopexy is contraindicated in individuals with:

• Segmental vas atresia or a detached epididymis (a condition that prevents blood flow to the testes) 
• Previous abdominal surgery that has caused adhesions in the abdominal wall

Before this surgery, you will need the following preparation:

• Your octor will conduct a physical exam and order the following tests to check your baby's overall health:
  • Blood or urine test
  • Ultrasound scan
  • Computed tomography (CT) scan
• Tell your doctor if your child takes any medications. The doctor may ask you to stop a few medicines for a week before the surgery.
• Notify the doctor if your child has a pacemaker, mechanical heart valve, or methicillin-resistant Staphylococcus aureus (MRSA) infection.
• Your child will have to abstain from food after midnight before the surgery. He will be allowed to drink clear liquids like water, breast milk, or juices for up to two hours before the surgery.
• If you agree to the procedure, you will be asked to sign a consent form.

Before the surgery, the doctor administers general anaesthesia to your childn keep him asleep and pain-free during the operation. The surgery will be done in the following way:

• The surgeon will either make a cut or several small cuts (in laparoscopic surgery, where a flexible, slender tube with a light source and camera at its tip is used) in the groin area of the child.
• He/she will locate the undescended testicle/testicles and the cord that holds them inside the scrotum and separate the cord from the surrounding tissues to help extend the testes and reach the scrotum. 
• Then, the surgeon will make a minor cut in the child’s scrotum to create a pouch. 
• He/she will place the testicles inside the scrotum pouch. 
• Finally, the surgeon will stitch the child’s testicles in place, and close the surgical cuts using dissolvable stitches.

The surgery may take about an hour for one testicle. After the surgery, your child will be monitored carefully until he wakes up and will be discharged on the same day as the surgery. However, in case your child has some other medical conditions, his hospital stay may extend.

Once your child is home, you will have to take the following care:

• Medications: 
  • You can give your child painkillers like paracetamol to reduce his pain after the surgery. However, consult your doctor for the proper dose and duration of the medicine. 
  • The doctor may also prescribe antibiotics (medications to destroy microorganisms that cause infection) and antiemetics (to prevent vomiting).
• Bathing/showering:
  • Do not give your child a bath for at least a week after the procedure. Instead, gently clean him with a fresh cloth and lukewarm water.. 
  • Do not use scented soaps.
• Wound care:
  • Keep the surgical area clean and dry until it heals.
  • If your child still wears nappies, make sure change them repeatedly. Otherwise, loose trousers and underwear can reduce the discomfort at the surgical site..

When to see the doctor?

Visit or call your child’s doctor immediately if he experiences the following symptoms after the surgery:

• Fever
• Chills
• Loss of appetite 
• Stomach pain 
• Fatigue 
• Increase in the intensity of pain 
• Difficulty in urinating 
• Continuous nausea or vomiting 
• Swelling, bleeding or bruising at the incision site
• Change in smell, appearance, volume, and frequency of urine
• Pus, redness, or tenderness around the surgical site

This surgery possesses the following risks:

• Infection 
• Allergy to certain medications or anesthesia used during the procedure
• Bleeding 
• Breathing problem 
• Testicular atrophy
• Inability to bring the testes inside the scrotum

A follow-up visit will be scheduled six to eight weeks after the surgery where the doctor will check the cosmetic outcome of the procedure.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.