Orchiopexy: bringing an undescended testicle down into the scrotum

Goal of the operation

To bring the undescended testicle down into the scrotum and fix it there. This protects the development of the testicle, makes it easier to examine in the future, lowers the risk of torsion and closes the hernia sac that has stayed open.

Methods

Open orchiopexy (palpable testicle)

• Groin approach: a 2–3 cm incision in the groin crease. The testicle and its blood vessels are freed, the open hernia sac next to it is closed, and then the testicle is placed in a small pocket made in the scrotum and stitched in place.
• Scrotal approach (Bianchi): if the testicle is low, near the top of the scrotum, the operation can be done through a single incision in the scrotum.

Laparoscopic orchiopexy (nonpalpable testicle)

The abdomen is examined with a 3–5 mm camera placed through the belly button.

• If the testicle is in the abdomen and its blood vessels are long enough, it is brought down into the scrotum in the same operation.
• If the testicle is very high, the Fowler-Stephens method is used: first the main blood vessels of the testicle are tied off, the testicle adapts to a new blood supply, and 6 months later it is brought down into the scrotum in a second stage.
• If the testicle has not developed, the remaining tissue is removed.

Day of surgery

• Fasting rules are followed before anesthesia (anesthesia in children).
• The operation is done under general anesthesia with local anesthesia.
• The child goes home a few hours after waking up, once he has eaten and had something to drink.

At home

• The incisions are closed with absorbable stitches and covered with glue or a clear dressing.
• A short shower after 48 hours; no long soaks in the bath for 1 week.
• For 2 weeks, no straddle toys (bicycle, rocking horse, ride-on cars).
• Acetaminophen (paracetamol) or ibuprofen for pain, dosed for age.
• Mild swelling and bruising of the scrotum go away within 1–2 weeks.

Follow-up

The testicle is checked 1–2 months and 6–12 months after surgery. An examination is also recommended in adolescence, and the boy is taught to examine his own testicles.