What is Orchidopexy?
Orchidopexy, also known as Orchiopexy, is a rehabilitative urological surgery to bring an undescended testicle (cryptorchid testis) into the scrotum and secure it there. Orchidopexy is usually performed in infants, children, or adults if a testis has failed to descend naturally. The goal of orchidopexy is to reduce the risk of cancer, preserve the potential fertility, facilitate evaluation, prevent testicular torsion, correct hernias, and improve the cosmetic appearance.
Types of Orchidopexy treatment
There are three main types of orchidopexy, based on factors like the location of the testicle, the length of the spermatic cord, and the overall health of the patient, namely
- Open Orchidopexy is a traditional form of surgery that is performed through a small cut in the groin or lower abdomen to mobilize the testicle and fix it inside the scrotum. This technique is best for palpable testicles found in the groin or just outside the scrotum.
- Laparoscopic Orchidopexy is another minimally invasive technique that uses small cuts and a camera to locate, evaluate, and reposition non-palpable testicles within the abdomen.
- Fowler- Stephends Orchidopexy (F-S) is a technique that is done laparoscopically. One-stage (F-S) is a technique where the gonadal vessels are divided in a single procedure to allow for the necessary length for reposition of the testis. Two-stage (F-S) involves dividing the vessels and temporarily clipping them, with a second procedure after six months to allow for collateral blood vessel development before the final repositioning of the testis. This is done when the spermatic vessels are too short, preventing the standard orchidopexy treatment.
| Procedure Name | Orchidopexy |
|---|---|
| Type of Surgery | Minor surgery |
| Type of Anesthesia | General or regional anesthesia |
| Procedure Duration | 1 Hour |
| Recovery Duration | Children, 2-3 days, and adults, a few days to a week or two |
Orchidopexy: Pre-Op & Post-Op Care
The procedure for Orchidopexy surgery is divided into three different phases: pre-operative phase, intra-operative phase, and post-operative phase. These phases are designed to make sure of patient safety, accuracy of procedure, and optimal recovery. The pre-operative stage is examining the patient and making them ready for surgery, which is followed by the surgical procedure itself during the intraoperative stage, and finally the post-operative stage, where the patient returns to normal activities after surgery becomes an essential objective.
Pre-operative Care for Orchidopexy
The first phase of any surgery is to make sure that the patient is ready for the safe conduct of the procedure.
An initial consultation is when a pediatric urologist or pediatric surgeon performs a physical evaluation, analyzes the patient’s history, and has a discussion that potentially includes the risks and benefits. In infants, an advanced imaging technique may be used to locate the undescended testicle.
Informed consent is when the surgeon and family sign a consent form, confirming that they have understood the procedure and have provided approval for it.
Fasting instructions are given to patients before surgery to reduce problems due to anesthesia, namely, no solid food for 8 hours, no formula or cow’s milk for 6 hours before, no breast milk for 4 hours, and no liquids, including water, for 2 hours.
Taking medicines needs to be managed, with blood thinners like aspirin that may have to be stopped for a short period of time.
Maintenance of Hygiene involves the patient being bathed with an antibacterial soap the day before and on the morning of surgery.
An anesthesiologist meets with the family of the infant patient, and prepares a plan that includes a claudal nerve block for extended relief postoperatively.
Providing emotional support is also essential for infants to help reduce anxiety.
Intra-Operative Care
The concerned surgical team conducts the surgery while keeping track of the patient’s vitals. General anesthesia is administered to the patient to make the patient pain-free.
The surgical team then keeps track of the patient based on the location of the testicle. Open orchidopexy in case of palpable testicle, and laparoscopic orchidopexy in case of non-palpable testicle. A small cut is then made in the scrotum to create a dartos pouch below the skin.
The testicle is then brought into the pouch and secured with stitches. The incisions are then covered with dissolving sutures or surgical glue and then covered with a dressing.
Post-operative care for Orchidopexy treatment
This is a phase that is concerned with the management of pain, treatment of wounds, and recovery.
The recovery room involves a patient being shifted to the recovery unit until waking up from anesthesia, while healthcare professionals continue to monitor the vitals.
Pain is managed by using medicines like acetaminophen and ibuprofen. In children, the prescribed main medicine is used in combination with codeine, as over-the-counter medications are insufficient. Thai medicines should be given regularly, along with the use of ice packs for 10-20 minutes at a time to reduce the swelling.
Wound care involves keeping the site of incision clean and dry. A pediatric surgeon provides guidelines on bathing and showering, which are usually avoided for several days. Dressings should be waterproof and should peel off on their own after a week or two of the surgery.
swelling, bruising, and a pinkish appearance of the incision are normal, along with a small dimple on the scrotum that usually settles down by itself within a few days.
Activity restrictions include rest for 1-2 days; light walking can be restarted after this. Adult patients should avoid contact sports or heavy lifting for at least 4-6 weeks. The diet should involve starting with clear liquids, and then the normal diet should be started, with oily foods being a strict no.
Follow-up care involves fixing an appointment with the surgeon to ensure proper healing.
A doctor should be immediately called upon if the fever is above 101.5° F, unbearable pain, not manageable by pain medications, Heavy bleeding, pus, or foul odour from incisions, Significant increase in redness or swelling.
Benefits of Orchidopexy at Yashoda Hospitals
- Decreases the risk of infertility
- Lowers the risk of testicular cancer
- Prevents testicular torsion
- Corrects the associated hernia with an undescended testicle
- Protection from injury
- Psychological benefits include high self-esteem
- Cosmetic appearance is also improved.
- Allows easier monitoring of cancer
- Increases hormonal function
- Supports normal sexual development
- Improves overall quality of life
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