Undescended Testis Surgery

Orchidopexy (Undescended Testis Surgery)

Orchidopexy (also known as orchiopexy) is a specialized surgical procedure used to move an undescended testicle from the abdomen or groin into the scrotum. This treatment is essential for preserving fertility, enabling early detection of potential health issues, and ensuring proper physical development.

When You Should Consider Orchidopexy

• Non-Palpable Testis: When a testicle cannot be felt in the scrotum during a routine physical exam by a pediatrician.

• Ectopic Testis: When the testicle has strayed from the normal path of descent and is located in an unusual position.

• Retractile Testis (Persistent): When a testicle frequently moves out of the scrotum and stays in the groin, making it difficult to bring down.

• Associated Hernia: When an undescended testicle is accompanied by an inguinal hernia that requires simultaneous repair.

• Optimal Timing: To achieve the best long-term outcomes, surgery is typically recommended between 6 and 12 months of age.

How Is Performed

• Anesthesia: The procedure is performed under general anesthesia and typically takes 45 to 90 minutes.

• Inguinal Orchidopexy: For a palpable testis, an incision is made in the groin to identify the testis and the spermatic cord.

• Mobilization: The surgeon carefully clears surrounding tissue or a hernia sac to ensure the cord is long enough to reach the scrotum without tension.

• Scrotal Pouch (Dartos Pouch): A second small incision is made in the scrotum to create a pocket where the testis is securely positioned.

• Laparoscopic Approach: For a testis high in the abdomen, a camera is inserted through the navel to guide the relocation.

• Fowler-Stephens Procedure: In complex cases with short vessels, this may be done in stages to allow secondary blood vessels to provide enough length for the testis to reach the scrotum.

Pre-Procedure Preparation

• Specialist Evaluation: A pediatric urologist performs a physical exam to determine if the testis is palpable or requires laparoscopic exploration.

• Imaging Workup: While not always required, an ultrasound or MRI may be used to help locate a non-palpable testis.

• Fasting: Patients must follow strict "nothing by mouth" (NPO) instructions for several hours before surgery to ensure safety during anesthesia.

• Health Screen: Ensuring the child is free of respiratory infections or fever on the day of the procedure.

Tests Before Orchidopexy

• Physical Assessment: The primary diagnostic tool used to grade the position and mobility of the testicle.

• Diagnostic Laparoscopy: Often the most definitive way to locate a testis that cannot be felt during a physical exam.

• Ultrasound: Used to visualize structures in the inguinal canal or abdomen if the diagnosis is unclear.

• Hormonal Testing: Occasionally recommended if neither testicle can be felt, to confirm the presence of testicular tissue.

Life After Orchidopexy

• Immediate Recovery: Most patients are able to go home the same day once they are awake and taking fluids.

• Wound Care: Incisions are usually closed with absorbable sutures and covered with surgical glue; sponge baths are recommended for the first 2–3 days.

• Pain Management: Discomfort is typically managed with paracetamol or ibuprofen; a local anesthetic block is often used during surgery for extended relief.

• Activity Restrictions: Children must avoid "straddle" toys (bicycles, rocking horses) and contact sports for 2 to 4 weeks to prevent the testis from retracting.

• Long-Term Monitoring: Follow-up visits at 6 weeks and 6–12 months ensure the testis remains in the correct position with healthy blood flow.

Why Specialized Treatment Is Highly Effective

• Fertility Preservation: Moving the testis to the cooler environment of the scrotum is vital for future sperm production.

• Hernia Repair: Allows for the simultaneous correction of any associated inguinal hernia.

• Reduced Risk: Early surgery significantly lowers the long-term risk of testicular torsion or injury.

• Improved Screening: Placing the testis in the scrotum allows for easy physical exams and early detection of any future irregularities.

• High Success Rates: Modern techniques provide excellent functional and aesthetic results with minimal recovery time.