An explanation of Orchidopexy and treatment options

Orchidopexy

Orchidopexy is an operation in which the Paediatric Surgeon moves an undescended testicle down into the base of the scrotum. An orchidopexy is indicated in those boys whose testicle has not fully descended into the scrotum by the age of 1 year of life.

Why does the operation need to be performed?

Orchidopexy is performed to maximise fertility, to minimise the chance of trauma or torsion (twist), to ensure cosmetic symmetry in the scrotum and to make it easier for the boy, when he is older, to check himself thoroughly for cancers of the testicle.

How is the operation performed?

Orchidopexy is performed as a day case procedure. Under a full general anaesthetic, a cut is made in the inguinal region of the groin as well as on the base of the scrotum. The Paediatric Surgeon identifies where the testicle is located and carefully mobilises it to a sufficient length to enable its placement within the scrotum. At the same time, the sac of a potential hernia which is present in up to 90% of cases, is also tied off and removed. Once fully mobilised, the testicle is passed down into the scrotum and placed in a pouch just below the skin. The stitches on the scrotum may be visible after the operation, however, they will dissolve of their own accord within 2-3 weeks. The stitches in the groin are under the skin and should not be visible. They also dissolve of their own accord but after 1-2 months. Whilst the child is asleep, the nerves to the scrotum and groin are anaesthetised with local anaesthetic. The operation takes approximately one hour.

What happens after the operation?

After the operation, the child is usually comfortable for 6-8 hours, after which time he may require regular pain relieving medication by mouth for 3-4 days. The child may shower or have a quick bath whenever he feels comfortable to do so. In most cases, the boys who undergo an orchidopexy have a week off school, but there is no necessary restriction to their activities.

What are the possible problems after the operation?

The two most common complications are bleeding/bruising and infection. Both the groin area and the scrotum may become significantly swollen and bruised following the operation, however, it is unusual that any further operations are required and this usually resolves of its own accord after 1-2 weeks. If either of the wounds become more red, more swollen and more sore rather than less so 2-3 days following the operation, then infection is almost certainly present. If infection occurs, it usually responds to a course of antibiotics. In some boys who have a particularly high testicle, the blood supply to the testicle may be damaged as a result of the operation. Parents are usually warned of this possibility before the operation. If this complication occurs, the testicle will become smaller, and may wither away to almost nothing over the subsequent weeks.

Will the operation be successful?

The results of the operation are usually excellent, however, in approximately 5% of cases a further operation may be necessary to bring the testicle down into the scrotum again as it may tend to drift higher as the boy becomes taller. Because of this possibility occurring, the Paediatric Surgeon will need to review the boy on a regular basis for some years after the operation.

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