What is orchiopexy?

Surgery to move an undescended testicle into the scrotum is called orchiopexy or orchidopexy. Surgery is usually recommended by the time the baby is 18 months old. In most cases, a pediatric surgeon or a specialist who treats urinary problems in children (pediatric urologist) does the surgery.

Orchiopexy may also be done on older boys. In rare cases, it may be done on teens and adult men who have undescended testicles.

Depending on the location of the testicle, one or two small incisions are made in the scrotum, the groin, or the abdomen. This allows the surgeon to reach the testicle and move it to the scrotum. Sometimes another type of surgery called laparoscopy is used to move undescended testicles. It may be done 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 in the abdomen, orchiopexy may require two separate operations that are done several months apart.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover. Lie down for 15 minutes several times each day for the first few days after surgery. This will help reduce the swelling of your scrotum.
• Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation.
• Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or aerobic exercise, for 1 to 2 weeks after surgery.
• Avoid lifting anything that would make you strain. This may include heavy grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, a vacuum cleaner, or a child.
• Do not drive for 1 to 2 weeks after surgery or until your doctor says it is okay.
• You may take showers. Pat the cut (incision) dry. Do not take a bath for 2 weeks or until your doctor tells you it is okay.
• Ask your doctor when it is okay for you to have sex.
• Most people are able to return to work or their normal activities within 1 to 2 weeks after surgery.

Diet

• You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.

Medicines

• Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision care

• Wash the area with warm, soapy water at least 2 times a day. Pat it dry. Don't use hydrogen peroxide or alcohol, which can slow healing.
• You may cover the area with a gauze bandage and hold it in place with your underwear. Keep the area clean and dry.

Ice

• Put ice or a cold pack on your scrotum for 10 to 20 minutes at a time. Try to do this every 1 to 2 hours (when you are awake) for the first day after surgery. Put a thin cloth between the ice and your skin.

Other instructions

• Wear snug underwear or compression shorts to support your scrotum for the first few weeks after surgery.

Usually the outcome of this surgery 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. In general, this treatment works well in almost all who need it.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Possible complications include:

• Infection.
• Bleeding or blood clots in the scrotum.
• Damage to the vas deferens and the blood supply to the testicle. Without enough blood supply, the testicle may shrink (atrophy).
• The testicle(s) moving out of the scrotum again (reascend) after surgery and needing more treatment. This is rare.

This surgery (orchiopexy) can be done as an outpatient procedure if it is uncomplicated. Sometimes a child needs a short hospital stay. The surgery for testicles that are 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.

For at least 2 weeks after surgery, your child 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 do a follow-up exam usually within 2 to 3 months after surgery.

You have had an orchiopexy (say "OR-kee-oh-peck-see"). In adults, it is usually done for testicle torsion. This occurs when your testicle twists, which twists the cord that provides it with blood. This cuts off blood from the testicle. It's usually an emergency, and the surgery takes place right away.

Your doctor made a cut, called an incision, in your scrotum and untwisted the cord. If the testicle looked like it was too damaged, your doctor probably removed it. Your doctor may have replaced the testicle with a prosthetic testicle, which is a plastic oval. This keeps the shape of your scrotum close to what it was before the surgery. The loss of one testicle should not change your ability to get an erection or father a child.

If the testicle is okay, your doctor attached it to your scrotum with stitches. This will keep the cord from twisting again. Your doctor also attached the other testicle to the scrotum so the cord will not twist in the future.

In most cases, doctors use stitches that dissolve on their own in 2 to 3 weeks and don't need to be removed. The incision will ooze fluid for 2 to 3 days.

You can expect to feel better each day, although you may have some mild to moderate pain for several days after surgery. You may need pain medicine during this time. Your scrotum will be swollen after surgery. This is normal. The swelling usually goes down within 2 to 4 weeks.

You should be able to do most of your normal activities after 1 to 2 weeks, except for those that require a lot of effort. It's important to avoid straining with bowel movements and doing heavy lifting while you recover.

• Follow the instructions exactly about when your child should stop eating and drinking. If you don't, the surgery may be canceled. If the doctor told you to have your child take his or her medicines on the day of surgery, have your child take them with only a sip of water.
• Have your child take a bath or shower before you come in. Do not apply lotion or deodorant.
• Your child may brush his or her teeth. But tell your child not to swallow any toothpaste or water.
• Do not let your child wear contact lenses. Bring your child's glasses or contact lens case.
• Be sure your child has something that reminds him or her of home. A special stuffed animal, toy, or blanket may be comforting. For an older child, it might be a book or music.

At the hospital or surgery center

• A parent or legal guardian must accompany your child.
• Your child will be kept comfortable and safe by an anesthesia provider.
• The surgery will take about 1 hour.
• After surgery, your child will be taken to the recovery room. As your child wakes up, the recovery room staff will monitor his or her condition. The doctor will talk to you about the surgery.
• You will probably be able to take your child home 2 to 4 hours after surgery.

The surgery (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 and may reduce the risk of testicular cancer.
• Treatment makes it easier to find testicular cancer if this cancer occurs.
• 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.
• This surgery helps lower the risk of injury to the testicle. If the testicles are in the groin area, a boy has a higher risk for sports injuries and discomfort from seat belts.